B. Zangbar1, L. Boudourakis2, V. Roudnitsky2, L. Dresner1 1State University Of New York Downstate Medical Center,General Surgery / Surgery / Medicine,Brooklyn, NY, USA 2Kings County Hospital Center,Trauma and Acute Care Surgery / Surgery / Medicine,Brooklyn, NY, USA
Introduction: Acute appendicitis in elderly patients carries an increased risk of complications and mortality. The benefits of laparoscopic appendectomy (LA) remain undefined as compared to open appendectomy (OA) in elderly patients, particularly in cases of perforated appendicitis. The aim of our study was to evaluate the outcomes of LA versus OA in perforated and non-perforated appendicitis in elderly.
Methods: Nationwide Inpatient Sample database was used to evaluate the clinical data of elderly patients (>65 years old) who underwent LA and OA over an 8-year period (2004-2011). Incidental and elective appendectomies were excluded. Univariate and Multivariate analysis was used.
Results: A total of 42,678 Elderly patients underwent urgent appendectomy in the United States during these years. The overall rate of perforated appendicitis was 28.4%, and 44.3% of all cases were performed laparoscopically. 21.4% of cases managed non-operatively. In non-perforated cases, LA was associated with lower overall complication rate (LA: 3.2% vs. OA: 7.9%; p < 0.001), shorter length of hospital stay (LOS, LA: 3.5 vs. OA: 6.7 days; p < 0.001), lower mortality (LA: 0.05% vs. OA: 1.9%; p < 0.001); and lower hospital charges (LA: $35,712 vs. OA: $46,345; p < 0.001) compared to OA. In perforated cases, LA had a lower overall complication rate (LA: 4.9% vs. OA: 10.4%; p < 0.001), shorter LOS (LA: 5.4 vs. OA: 7.7 days; p < 0.001), lower mortality (LA: 1.1% versus OA: 2.3%; p < 0.001), and lower hospital charges (LA: $42,823 versus OA: $51,393; p < 0.001) compared to OA.
Conclusion: LA has clear mortality and morbidity advantage in elderly patients with acute perforated and non-perforated appendicitis, and is associated with shorter hospital stay and lower hospital charges. Given their higher complication tendency and reduced physiological reserve, in elderly patients, laparoscopic appendectomy should be the standard of care.