R. Mehta1, A.M. Jose2, A. Rafieezadeh2, K. Prabhakaran2, J.M. Kirsch2, I. Shnaydman2, J. Klein2, G. Froula2, M. Bronstein2, B. Zangbar2 1Westchester Medical Center, Surgery, Valhalla, NY, USA 2New York Medical College, Surgery, Valhalla, NY, USA
Introduction: Appendectomy is a common general surgery procedure, but special considerations are necessary when performing it on the elderly due to increased risks and complications in this demographic. The aim of this study is to evaluate the outcomes of laparoscopic appendectomy versus open appendectomy for acute appendicitis in the elderly population.
Methods: We analyzed data from the Nationwide Inpatient Sample (2016 – 2019). Patients who are ≥ 65 years diagnosed with an appendicitis and required appendectomy were grouped based on their primary procedure: Laparoscopic appendectomy (LA) and open appendectomy (OA). Patients who underwent elective appendectomy were excluded. The primary outcome was mortality, and secondary outcomes included length of stay (LOS), discharge disposition, complications and cost of procedure. Complications were defined as myocardial infarction, pneumonia, acute kidney injury, deep vein thrombosis, pulmonary embolism, intrabdominal abscess, and small bowel obstruction.
Results:Out of 14,115 patients diagnosed with acute appendicitis, 10,500 (74.4%) patients underwent appendectomy. The mean age was 73.53 ± 6.78 years with 52.1% being females. 20.4% were ≥ 80 years. 65.4% had complicated appendicitis. Laparoscopic appendectomy was performed in 81.9% of cases. OA had a higher mortality (2.3% vs. 0.5%) and complications (29.2% vs. 15.0%) (p < 0.001) compared to LA. OA had a longer LOS (8.07 ± 6.98 days) compared to LA (4.08 ± 4.21 days). LA were more often discharged home (81.6% vs. 56.6%, p< 0.001). Among patients with a perforated appendicitis, 78.2% underwent LA and 21.8% underwent OA with OA (2.4%) having a higher mortality and longer LOS compared to LA (0.3%) (p = 0.005). Among patients with generalized peritonitis, 30.5% underwent OA and 22.5% underwent LA with LA having a lower mortality (0.8% vs. 3.3%). Among patients ≥ 80 years, LA (1.1%) had a lower mortality rate than OA (3.5%). After adjusting for age, sex, race, comorbidities, multivariate regression showed that open appendectomy increased the odds of mortality three-fold (3.854 [2.487-5.973], p < 0.001).
Conclusion:LA appears to be safer than OA with lower overall mortality, even among octogenarians. LA is associated with shorter hospital stay, less complications and lower total cost in elderly in both perforated and non-perforated appendicitis.