Elsevier

Surgery

Volume 135, Issue 5, May 2004, Pages 479-488
Surgery

Surgical outcomes research
Laparoscopic appendectomy in the elderly☆

https://doi.org/10.1016/j.surg.2003.12.007Get rights and content

Abstract

Background

Evidence suggests that laparoscopic appendectomy (LA) has advantages over open appendectomy (OA) in the treatment of appendicitis. It remains, however, unclear whether LA is indicated in the elderly patient population.

Methods

Patients with primary International Classification of Diseases, revision 9, procedure codes for LA (n = 32,406 patients) and OA (n = 112,884 patients) were selected from the 1998, 1999, and 2000 Nationwide Inpatient Samples. The end points that were under investigation were the length of hospital stay, the rate of routine discharge, and in-hospital morbidity and mortality rates. Multiple linear and logistic regression analyses were performed to assess the risk-adjusted association between the surgery type and the patient outcomes. Stratified analyses were performed according to age (65 years and older; less than 65 years old) and to the presence of appendiceal perforation or abscess.

Results

After risk adjustment, patients who underwent LA had a significantly shorter mean length of stay (LA, 2.45 days; OA, 3.71 days; P <. 0001), higher rate of routine discharge (odds ratio, 2.80; P < .0001), lower overall complication rate (odds ratio, 0.92; P = .03), and mortality rate (odds ratio, 0.23; P = .001) compared with OA patients. Similar benefits of LA were found in the strata of patients who were less than 65 years old, in elderly patients, and in patients with appendiceal perforation or abscess.

Conclusion

LA has statistically significant advantages over OA with respect to the length of hospital stay, the rate of routine discharge, and postoperative morbidity and mortality rates for patients who are less than 65 years old, in elderly patients, and in patients with appendiceal abscess or perforation.

Section snippets

Study population and description of databases

Data for patients with International Classification of Diseases, revision 9 (ICD-9), procedure codes for LA (47.01) or OA (47.09) were selected from the 1998, 1999, and 2000 Nationwide Inpatient Samples (NIS).11., 12., 13. Patient data with primary diagnosis codes other than appendicitis and with any procedure code of incidental appendectomy were excluded from our analysis (Appendix I). The NIS are among the largest publicly available in-patient databases in the United States. The 1998, 1999,

Results

Our database contained information about 148,660 patients who underwent LA or OA. After the exclusion of patients with a diagnosis of appendicolithiasis and appendicopathia oxyurica (n = 2659) and patients who underwent incidental appendectomies (n = 711), 145,290 patients remained in our analyses: 32,406 patients (22.3%) underwent LA; 112,884 patients (77.7%) underwent OA; 9476 patients (6.5%) were equal to 65 years of age and older; 135,814 patients (93.5%) were less than 65 years of age.

In both

Discussion

This is the first investigation based on data from large nationwide databases that assess important end points in both patients less than 65 years old and elderly patients who have undergone LA and OA for appendicitis. The findings of the present investigation confirm our previous results for the overall patient population, with LA having significant advantages over OA in terms of mean length of hospital stay (LA, 2.45 days; OA, 3.71; P<.0001), rate of routine discharge (OR, 2.80; 95% CI [2.43,

Acknowledgements

We thank the Division of Orthopedic Surgery, Duke University Medical Center, Durham, NC, for providing the 1998, 1999, and 2000 Nationwide Inpatient Samples.

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    ☆

    Supported in part by the Swiss National Foundation, Bern/Switzerland, Krebsliga beider Basel, Basel/Switzerland, Freiwillige Akademische Gesellschaft, Basel/Switzerland, and Fondazione Gustav e Ruth Jacob, Aranno/Switzerland (U.G.).

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