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Is laparoscopic surgery safe for elderly patients with diverticulitis? A national database study

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Abstract

Purpose

Laparoscopy is the preferred approach to elective surgery for diverticulitis and is increasingly common in the emergent setting. Although diverticulitis is most prevalent among older adults, little is known about the safety of laparoscopy for elderly patients with diverticulitis. This study aims to compare 30-day outcomes of a laparoscopic versus open approach for diverticulitis among elderly patients undergoing elective and urgent/emergent surgery.

Methods

Patients ≥ 65 years who underwent surgery for diverticulitis from 2015 to 2019 were identified from the ACS-NSQIP database. Elective and non-elective groups were analyzed separately. Coarsened exact matching matched laparoscopic and open patients 1:1 based on preoperative factors to minimize selection bias by creating comparable cohorts. Short-term outcomes of laparoscopic versus open surgery were compared.

Results

A total of 15,316 patients were included, 69.2% female and 88% White, with a mean age of 72.7 ± 6.1 years. Approximately half (50.9%) of cases were laparoscopic and 60.6% were elective. After matching, laparoscopy was associated with lower 30-day morbidity in both the elective (OR, 0.47; 95%CI, 0.38–0.58) and non-elective (OR, 0.76; 95%CI, 0.58–0.98) cohorts. Laparoscopic surgery in both cohorts was associated with fewer surgical site infections (SSIs) (elective, OR 0.43; 95%CI, 0.33–0.57; non-elective, OR, 0.66; 95%CI, 0.44–0.98) and shorter length of stay (LOS) (elective, mean difference, 1.7 days; 95%CI, 1.5–1.9; non-elective, mean difference, 1.2 days; 95%CI, 0.43–2.1).

Conclusion

Elderly patients undergoing both elective and non-elective laparoscopic surgery for diverticulitis have less 30-day morbidity, SSIs, and shorter LOS compared to an open approach. Therefore, laparoscopy for elderly patients is safe in elective surgery and in select emergent cases as well.

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Author information

Authors and Affiliations

  1. Division of Colon & Rectal Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA

    Caitlyn Braschi, Jessica K. Liu & Beverley A. Petrie

  2. Division of General & Bariatric Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA

    Ashkan Moazzez

Authors
  1. Caitlyn Braschi
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  2. Jessica K. Liu
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  3. Ashkan Moazzez
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  4. Beverley A. Petrie
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Contributions

Study conception and design, Braschi, Moazzez, and Petrie. Acquisition of data, Moazzez. Analysis and interpretation of data, Moazzez and Braschi. Drafting of manuscript, Braschi, Liu, Moazzez, and Petrie. Critical revision of manuscript, Braschi, Liu, Moazzez, and Petrie.

Corresponding author

Correspondence to Ashkan Moazzez.

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Disclosures

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Competing interests

The authors declare no competing interests.

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Braschi, C., Liu, J.K., Moazzez, A. et al. Is laparoscopic surgery safe for elderly patients with diverticulitis? A national database study. Langenbecks Arch Surg 407, 3599–3606 (2022). https://doi.org/10.1007/s00423-022-02695-2

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  • DOI: https://doi.org/10.1007/s00423-022-02695-2

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