E. H. Chang1, P. Chung3, M. J. Lee1, M. Smith5, K. Barrera1, V. Roudnitsky2, A. Alfonso4, G. Sugiyama4 1State University Of New York Downstate Medical Center,General Surgery,Brooklyn, NY, USA 2Kings County Hospital Center,Division Of Trauma And Acute Care Surgery,Brooklyn, NY, USA 3Coney Island Hospital,Department Of General Surgery,Brooklyn, NY, USA 4Hofstra Northwell School Of Medicine,Department Of Surgery,Hempstead, NY, USA 5Vanderbilt University Medical Center,Department Of Trauma Surgery,Nashville, TN, USA
Introduction: The number of octogenarians is projected to increase four-fold by the year 2050. Laparoscopic surgery (LAP) has been associated with decreased length of stay and pain, however the open approach is often employed for small bowel obstruction (SBO). Our aim was to compare laparoscopic surgery (LAP) in the octogenarian population in patients presenting with SBO from adhesive disease with the traditional open exploratory approach.
Methods:
An observational study utilizing ACS NSQIP from 2006-2014 was performed. Patients ≥80 years of age, who underwent emergency surgery within one day of admission with a postoperative diagnosis of intestinal/peritoneal adhesion with obstruction (ICD9 560.81) were included in the study. Risk variables of interest included: age, sex, race, BMI, preoperative sepsis, ASA classification, length of stay (LOS), postoperative mortality, and postoperative pneumonia. Univariable analysis was performed using Student’s t-test and Wilcoxon Rank Sum Test for continuous variables while Fisher’s Exact Test and Chi-square Test for categorical variables. Multivariable analysis was performed using Logistic Regression.
Results:
A total of 103 LAP and 692 open cases were identified. There were no significant differences in age (p=0.1518), sex (p=0.7994), BMI (p=0.1151), or race (p=0.3722) between the groups. However, the open group tended to have higher ASA class (p=0.0225) and incidence of preoperative sepsis (p=0.01597). Unadjusted outcomes showed longer LOS in open vs LAP (median 4.0 vs 8.0 days, p<0.0001), higher incidence of postoperative mortality in open vs LAP (p=0.0071), and higher incidence of postoperative pneumonia in open vs LAP (p=0.0032). Logistic regression with postoperative mortality and pneumonia ad dependent variables were performed adjusting for preoperative risk variables and LAP vs Open. Age (OR 1.11, 95%CI 1.01-1.22, p=0.0311) and preoperative sepsis (OR 3.77, 95%CI 1.06-12.02, p=0.0287) were associated with mortality. Male sex (OR 2.68, 95%CI 1.58-4.60, p=0.0003) and open procedure (OR 5.03, 95%CI 1.50-31.34, p=0.0282) were associated with postoperative pneumonia.
Conclusion:
We compared outcomes after LAP vs open adhesiolysis for adhesive SBO in the octogenarian population. Adjusting for multiple preoperative variables and LAP vs open approach, we found that age and presence of preoperative sepsis, but not procedure type, was associated with mortality. Therefore, octogenarians who present with SBO due to adhesive disease may benefit from an initial laparoscopic approach. Further prospective studies are warranted.