Laparoscopic segmental colectomy for octogenarians: Is 80 the new 60?

Maria C Mora Pinzon, MD, Jacqueline Fiala, Amanda B Francescatti, BA, Marc I Brand, MD, Dana M Hayden, MD, MPH, Theodore J Saclarides, MD, FACS

Rush University Medical Center, Loyola University Medical Center,

Background: Increasing life expectancy is accompanied by increasing prevalence of medical comorbidities. Elderly patients have a higher surgical risk, and higher complication rate than younger patients. The purpose of our study was to compare outcomes of segmental laparoscopic colectomy for patients ≥ 80 years old with those <less than 80.

Methods: Retrospective analysis was performed on a prospectively collected database of patients who underwent laparoscopic segmental colectomy between 2002 – 2012. Outcomes in patients 80 years and older were compared to their younger counterparts, and to patients ≥ 80 years that underwent open surgery.

Results: 376 patients underwent laparoscopic segmental colectomy. 58.3% were female, and the mean age was 61.6 years (range 16 – 98). 31 patients (8.2%) were 80 years and older. The most common indications for surgery in ≥80 patients were: cancer (45.2%), benign tumor/polyp (25.8%) and diverticular disease (12.9%). There was no difference in regards to indication for surgery when compared to those <80 (X2=4.184 p=0.123). The overall complication rate was 16.1% in patients ≥ 80, and there was no significant difference when compared to younger patients (16.1 vs. 29.6% p=0.112). Risk of SICU admission (X2= 0.003 p=0.960), emergency readmission (X2= 0.072 p=0.789) or complications after 30 days (X2= 0.327 p=0.568) were also similar. Length of stay decreased in patients ≥ 80; this trended toward significance (5.03 vs. 7.28 p=0.076). A second analysis was performed comparing open vs. laparoscopic colectomy in patients >80 over the same time period. The laparoscopic group had lower rates of ileus (X2= 4.439, p=0.036), and hemodynamic instability (X2= 6.118, p=0.016). Readmission and 30 days complication rates were equal (p=0.448, and p=0.566 respectively). Surprisingly there was no difference in operative time (186.65 vs. 162.89, p=0.091). However, length of stay was significantly shorter in the laparoscopic group (5 vs. 9.79, t=-4.916 p=0.000).

Conclusions: Laparoscopic surgery in octogenarians can be performed safely without increased risk of complications, and with the added benefits of laparoscopy demonstrated in younger populations. Our study also shows that compared to open surgery, there is lower risk of postoperative complications, and shorter length of stay when patients >80 have laparoscopic colectomy.

Key words: octogenarian, laparoscopy, colectomy

Session: Poster Presentation

Program Number: P080

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