Does Laparoscopic Appendectomy Impart an Advantage Over Open Appendectomy in Elderly Patients?

Hossein Masoomi, MD, Steven D Mills, MD, Matthew O Dolich, MD, Vicrumdeep Tung, MD, Joseph C Carmichael, MD, Michael J Stamos, MD. University of California, Irvine – Medical Center

Introduction: The use of laparoscopy in the elderly has been increasing in recent years. There is minimal data comparing laparoscopic (LA) with open appendectomy (OA) in elderly patients.
Objectives: Our study was intended to evaluate outcomes of LA versus OA in elderly patients (65 years and over).
Methods: Using the Nationwide Inpatient Sample database (NIS), clinical data of elderly patients who underwent LA and OA for suspected acute appendicitis were evaluated from 2006 to 2008. Incidental and elective appendectomies were excluded. Outcome measures included patient characteristics (age, sex and race), comorbidities, postoperative complications, length of hospital stay (LOS), and in-hospital mortality.
Results: A total of 65,464 elderly patients underwent urgent appendectomy during this period (7.7% of all appendectomies). 50.35% of patients were female and 81% Caucasian. The mean age was 74. The rate of perforated appendicitis was twice as high in elderly patients (50% vs. 25%, p<0.01) and rate of LA in elderly patients was significantly lower (52% vs. 63%, p<0.01) compared to patients less than 65 years old.
In elderly patients with acute non-perforated appendicitis, LA had significantly lower overall postoperative complications (19.21% vs. 30.96%, p<0.01), in-hospital mortality (0.39% vs. 1.31%, p<0.01), hospital charges ($30,189 vs. $34,002, p<0.01) and shorter mean LOS (2.97 vs. 4.83 days, p<0.01) compared with OA.
Also in acute perforated appendicitis in elderly patients, LA was associated with lower overall postoperative complications (46.82% vs. 68.65%, p<0.01), in-hospital mortality (1.40% vs. 2.63%, p<0.01) and mean hospital charges ($43,319 vs. $57,583, p<0.01) and shorter mean LOS (5.86 vs. 8.69 days, p<0.01).
Conclusion: Laparoscopic appendectomy can be performed safely with significant advantages compared to open appendectomy in the elderly and should be considered the procedure of choice for perforated and non-perforated appendicitis in these patients.