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Mortality from appendicitis is increasing in the elderly at the same time it is decreasing in the population at large. What factors are responsible for this excess mortality? In a retrospective study of 94 patients over age 60 with appendicitis, the authors found that delays in correct diagnosis and surgical intervention led to a significant increase in the perforation rate. They maintain that a high index of suspicion and prompt surgical intervention would improve the outcome in this age-group.