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Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study

  • Gaetano Poillucci
  • Mauro PoddaEmail author
  • Adolfo Pisanu
  • Lorenzo Mortola
  • Patrizia Dalla Caneva
  • Giulia Massa
  • Gianluca Costa
  • Riccardo Savastano
  • Nicola Cillara
  • On behalf of the ERASO (Elderly Risk Assessment And Surgical Outcome) Collaborative Study Group
Original Article
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Abstract

Background

A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65 years.

Methods

Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy.

Results

Between January 2017 and June 2018, 135 patients aged ≥ 65 years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61–0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12–3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11–6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05–3.89).

Conclusions

In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.

Keywords

Acute appendicitis Appendectomy Elderly Postoperative complications Frail patients 

Notes

Acknowledgements

The authors thank Dr. David C. Nilson, Ph.D., for revising the English. List of ERASO Collaborative Study Group members on behalf of SICUT (Italian Society of Emergency and Trauma Surgery), ACOI (Italian Society of Hospital Surgeons), SICG (Italian Society of Geriatric Surgery), SICE (Italian Society of Endoscopic Surgery and New Technologies), and the WSES (World Society of Emergency Surgery) Italian Chapter: Agresta F, Alemanno G, Anania G, Antropoli M, Argenio G, Atzeni J, Avenia N, Azzinnaro A, Baldazzi G, Balducci G, Barbera G, Bellanova G, Bergamini C, Bersigotti L, Bianchi PP, Bombardini C, Borzellino G, Bozzo S, Brachini G, Buonanno GM, Canini T, Cardella S, Carrara G, Cassini D, Castriconi M, Ceccarelli G, Celi D, Ceresoli M, Chiarugi M, Cillara N, Cimino F, Cobuccio L, Cocorullo G, Colangelo E, Costa G, Crucitti A, Dalla Caneva P, De Luca M, De Manzoni Garberini A, De Nisco C, De Prizio M, De Sol A, Dibella A, Falcioni T, Falco N, Farina C, Finotti E, Fontana T, Francioni G, Fransvea P, Frezza B, Garulli G, Genna M, Giannessi S, Gioffrè A, Giordano A, Gozzo D, Grimaldi S, Gulotta G, Iacopini V, Iarussi T, Laterza E, Leonardi A, Lepre L, Lorenzon L, Luridiana G, Malagnino A, Mar G, Marini P, Marzaioli R, Massa G, Mecarelli V, Mingoli A, Nigri G, Occhionorelli S, Paderno N, Palini GM, Paradies D, Paroli M, Perrone F, Petruzzelli L, Pezzolla A, Piazza D, Piazza V, Piccoli M, Pisanu A, Podda M, Poillucci G, Porfidia R, Rossi G, Ruscelli P, Spagnoli A, Sulis R, Tartaglia D, Tranà C, Travaglino A, Tomaiuolo P, Valeri A, Vasquez G, Zago M, Zanoni E.

Author contributions

GP study conception and design, literature search, data acquisition, interpretation and analysis; drafting and critically revising the article for important intellectual content; final approval of the version to be published. MP study conception and design, literature search, data acquisition, interpretation and analysis; drafting and critically revising the article for important intellectual content; editing and revising the English for the final version to be published; final approval of the version to be published. AP data interpretation and analysis; drafting and critically revising the article for important intellectual content; and final approval of the version to be published. LM data interpretation and analysis; drafting and critically revising the article for important intellectual content; and final approval of the version to be published. PDC data acquisition, interpretation and analysis; drafting and critically revising the article for important intellectual content; final approval of the version to be published. GM data interpretation and analysis; critically revising the article for important intellectual content; and final approval of the version to be published. GC study conception and design, literature search, data acquisition, interpretation and analysis; drafting and critically revising the article for important intellectual content; final approval of the version to be published. RS data interpretation and analysis; drafting and critically revising the article for important intellectual content; final approval of the version to be published. NC study conception and design, literature search, data acquisition, interpretation and analysis; drafting and critically revising the article for important intellectual content; final approval of the version to be published.

Funding

This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

Gaetano Poillucci, Mauro Podda, Adolfo Pisanu, Lorenzo Mortola, Patrizia Dalla Caneva, Lorenzo Mortola, Giulia Massa, Gianluca Costa, Riccardo Savastano and Nicola Cillara have no conflict of interest to declare.

Ethical approval

This study was approved by the Ethics Committee of the University “La Sapienza” (Rome, Italy. Protocol ID: Rif_CE_452_2016) and secondary approval was obtained from all ethics committees of the other participating centers. The study protocol was registered at ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT02825082).

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Gaetano Poillucci
    • 1
  • Mauro Podda
    • 2
    Email author
  • Adolfo Pisanu
    • 2
  • Lorenzo Mortola
    • 3
  • Patrizia Dalla Caneva
    • 3
  • Giulia Massa
    • 4
  • Gianluca Costa
    • 4
  • Riccardo Savastano
    • 5
  • Nicola Cillara
    • 6
  • On behalf of the ERASO (Elderly Risk Assessment And Surgical Outcome) Collaborative Study Group
  1. 1.Department of General Surgery “Paride Stefanini”, Policlinico Universitario Umberto ISapienza UniversityRomeItaly
  2. 2.Department of General, Emergency and Minimally Invasive Surgery, Policlinico Universitario “D. Casula”University of CagliariMonserratoItaly
  3. 3.Department of Surgery, Policlinico Universitario “D. Casula”University of CagliariMonserratoItaly
  4. 4.Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching HospitalSapienza UniversityRomeItaly
  5. 5.Department of StatisticsUniversity of SalernoSalernoItaly
  6. 6.Department of SurgerySantissima Trinità HospitalCagliariItaly

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