Thirty Day Outcomes of Laparoscopic Versus Open Appendectomy in Elderly Using Acs/nsqip Database

Ashkan Moazzez, MD FACS, Rodney J Mason, MD PhD FACS, Namir Katkhouda, MD FACS. H. Claude Hudson Comprehensive Health Center, University of Southern California

INTRODUCTION: Although laparoscopic appendectomy (LA) is becoming the procedure of choice rather than open appendectomy (OA) in treatment of appendicitis in general population, its role has not been widely studied in the elderly. The objective of this study is to compare the 30-day outcomes after LA versus OA for appendicitis in elderly patients in ACS/NSQIP hospitals.

METHODS AND PROCEDURES: Using the ACS/NSQIP database for years 2005 through 2009, 3674 patients (age>65) who underwent an appendectomy for appendicitis were identified. Seventy two percent of the procedures were performed laparoscopic. The association between surgical approach and overall morbidity, serious morbidity and mortality were analyzed.

RESULTS: Patients who underwent an open appendectomy had a longer length of stay (4.7 vs 2.9 days, p<0.001), and a not clinically, but statistically significant longer operative time (54.3 vs. 51.7 min, p=0.02). This group of patients also had a higher rate of overall morbidity (13.4% vs 8.2%, p<0.001) and mortality (2% vs. 0.9%, p=0.003), but same rate of serious morbidity (6.7% vs. 5.2%, p=0.08). In a subgroup analysis, while patients with ASA class of 1 and 2 had the same overall morbidity and mortality rate in LA and OA, patients with ASA class of 3 or 4 had a higher overall morbidity (19.4% vs. 11.9%, p<0.001) and mortality (3.9% vs. 1.8%, p=0.009).

CONCLUSION: Within ACS NSQIP hospitals, elderly patients benefited from laparoscopic approach to appendicitis in regards to length of stay and had a lower overall morbidity and mortality. This was also the case in patients with higher ASA classes.