Laparoscopic appendectomy is safe and efficacious for the elderly: an analysis using the National Surgical Quality Improvement Project database
- 7 February 2011
- journal article
- Published by Springer Nature in Surgical Endoscopy
- Vol. 25 (6), 1802-1807
- https://doi.org/10.1007/s00464-010-1467-2
Abstract
Despite increasing use of laparoscopic appendectomy, data demonstrating outcomes of this technique exclusively among the elderly population are scarce. This study aimed to compare 30-day postoperative morbidity and length of hospital stay among elderly patients after appendectomy. Appendicitis patients older than 65 years were extracted from the National Surgical Quality Improvement Project (NSQIP) database. Demographics and rates of complications for patients undergoing open and laparoscopic appendectomies were compared. Uni- and multivariate analyses adjusted for differences between groups compared the end points of major and minor complications as well as the days of hospital stay after initial surgery. A total of 3,335 patients underwent appendectomy, with 2,235 patients (67%) receiving a laparoscopic procedure. The open appendectomy patients were significantly older and more likely to have various preoperative comorbidities (p < 0.05). No difference in median operative time between the two techniques was found. Both required 51 min (p = 0.11). The open cases had higher rates of both major and minor postoperative complications than the laparoscopic cases (p < 0.0001), both overall and before discharge. Multivariate analysis showed no association between operative approach and major complications, and a reduced risk of minor complications with laparoscopy. Length of surgical stay was longer for the open group than for the laparoscopically treated group (median, 4 days vs 2 days; p < 0.05). After adjustment, laparoscopy still was significantly associated with a shorter hospital stay than open appendectomy (p < 0.0001). Laparoscopic appendectomy is a safe procedure for elderly patients. During the 30-day postoperative period, no correlation with major complications was found, and the findings showed a beneficial association with regard to minor complications. After adjustment for perioperative factors, laparoscopy is associated with a shorter hospital stay than open appendectomy.Keywords
This publication has 14 references indexed in Scilit:
- Balancing the Risk of Postoperative Surgical InfectionsAnnals of Surgery, 2010
- Choice of Approach for Appendicectomy: A Meta-analysis of Open Versus Laparoscopic AppendicectomySurgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2007
- Appendicitis in the elderly: a change in the laparoscopic eraSurgical Endoscopy, 2007
- Laparoscopic Versus Open Appendectomy: A Prospective, Randomized, Double-Blind StudyAdvances in Surgery, 2006
- Advantages of Laparoscopic Appendectomy in the ElderlyThe American Surgeon, 2006
- Laparoscopic Versus Open AppendectomyAnnals of Surgery, 2005
- Laparoscopic appendectomy in the elderlySurgery, 2004
- What have we learned over the past 20 years about appendicitis in the elderly?The American Journal of Surgery, 2003
- A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: Clinical and economic analysesSurgery, 2001
- Appendicitis In The ElderlyAnz Journal of Surgery, 2000