Laparoscopic Appendectomy Is Safe and Efficacious in the Elderly: An Analysis Using the Nsqip Database.

Introduction
While laparoscopic appendectomy has been increasingly utilized, there is a paucity of data pertaining to its use exclusively in the elderly population. The aim of this study was to examine patterns in 30-day post-operative morbidity and related patient factors in elderly patients following appendectomy.

Methods
Cases of appendicitis in patients over the age of 65 were extracted from the National Surgical Quality Improvement Project (NSQIP) database covering the years 2005 through 2008. Current Procedural Terminology codes were used to separate cases treated with open appendectomy versus laparoscopic appendectomy. Cases converted from a laparoscopic to an open approach were categorized as laparoscopic for the purposes of analysis. Demographics of patients in both procedural categories as well as rates of complications were calculated. Univariate and multivariate analyses of the two groups were conducted in order to adjust for differences between groups and compare outcomes related to each procedure.

Results
3335 patients underwent appendectomy with 2235 patients (67%) receiving a laparoscopic procedure. Patients who underwent an open appendectomy were significantly older, more likely to be current smokers, had a higher ASA class, and more likely to have a class four wound (p < 0.05). There was no difference in median operative time between techniques: 51 minutes for both (p = 0.11). Open appendectomy cases were significantly associated with certain post-operative complications as compared to the laparoscopic approach: pneumonia (2.6% vs. 1.2%, p < 0.05), DVT (1.3% vs. 0.4%, p < 0.05), and return to OR (4.6% vs. 2.5%, p < 0.05). Length of surgical stay was longer for the open group compared to the laparoscopically treated group (median 4 days vs. 2 days, p < 0.05). Rates of incisional infections were also significantly higher in the open vs. the laparoscopic group (5.9% vs. 2.2%, p < 0.05). When controlling for other patient characteristics, open appendectomy was still significantly associated with a higher rate of incisional wound infection.

Conclusion
Laparoscopic appendectomy in elderly patients is a safe procedure with regards to 30-day post-operative morbidity and demonstrates a benefit of decreased wound infection rates as compared to the open approach.


Session: Podium Presentation

Program Number: S070

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