M. M. Symer1, J. Abelson1, T. Sun2, A. Sedrakyan2, H. Yeo1,2 1Weill Cornell Medical College,Surgery,New York, NY, USA 2Weill Cornell Medical College,Healthcare Policy And Research,New York, NY, USA
Introduction: Appendectomy is one of the most common surgical procedures in the U.S., with up to 30% of patients presenting with perforation. Despite this, there is no consensus on the optimal surgical management of perforated appendicitis. Older adults have increased operative risk and may represent a subgroup of patients for whom ideal management differs from the general population. In older adults, timing of intervention, as well as the use of laparoscopy may be especially beneficial. We performed a large database analysis of outcomes in early versus delayed surgery for perforated appendicitis in octogenarians.
Methods: We analyzed the New York Statewide Planning and Research Cooperative database, an all-payer, in- and out-patient database which captures all admissions and surgeries in New York State. ICD-9 codes were used to identify all patients ≥80 years old undergoing appendectomy for perforated appendicitis from 2000 to 2013. Primary outcome was any complication within one year of follow up. Secondary outcomes included length of stay, hospital charges, utilization of laparoscopy, and readmission rate. Outcomes were compared in patients undergoing appendectomy before or after 48h from admission.
Results: 1691 patients were identified for analysis, 1407(83.2%) of whom underwent early appendectomy. Patients undergoing delayed appendectomy were more likely to have a complication (71.5% vs 59.8%, p<0.01). Rates of laparoscopy utilization were low overall, particularly in the late appendectomy group (27.1% vs 33.5%, p<0.01). After multivariate adjustment, patients undergoing delayed surgery were more likely to have complications (OR 1.62 95%CI 1.19-2.19), high hospital costs (OR 3.22 95%CI 2.23-4.65), and a prolonged length of stay (OR 5.06 95%CI 3.54-7.24). The only complication more common in the early group was a cardiac complication, and overall rates of cardiac complications were low (7.2% vs 3.9%, p=0.04).
Conclusion: We present a population-level study of early versus late appendectomy in octogenarians with perforated appendicitis. The nonoperative approach is associated with fewer cardiac complications, but is associated with having any complication, longer length of stay, and higher cost. Laparoscopy use is low in older adults with perforated appendicitis, regardless of timing of intervention.