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Thirty-day outcomes of laparoscopic versus open appendectomy in elderly using ACS/NSQIP database

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Abstract

Background

Although laparoscopic appendectomy is becoming the procedure of choice over open appendectomy in the treatment of appendicitis, its role in the elderly has not been widely studied. The objective of this study was to compare the 30-day outcomes after laparoscopic versus open for appendicitis in the elderly patients.

Methods

Using the American College of Surgeons National Surgical Quality Improvement Program (ACS/NSQIP) databases for years 2005–2009, 3,674 patients (age >65 years) who underwent an appendectomy for appendicitis were identified. Seventy-two percent of the procedures were performed laparoscopically. In addition to aggregate cohort analysis, propensity score 1:1 matching was used to minimize the treatment selection bias. The association between surgical approach and morbidity, mortality, and length of stay (LOS) were analyzed.

Results

In the aggregate cohort analysis, patients who underwent an open appendectomy had a higher rate of minor morbidity (9.3% vs. 4.5%; p < 0.001), overall morbidity (13.4% vs. 8.2%, p < 0.001), and mortality (2% vs. 0.9%, p = 0.003). However, in the matched cohort analysis, open appendectomy was only associated with a higher rate of minor morbidity (9.3% vs. 5.7%; p = 0.002) and overall morbidity (13.4% vs. 10.1%; p = 0.02) but similar mortality rates (2% vs. 1.5%; p = 0.313). In matched cohort analysis, open appendectomy also was associated with a higher rate of superficial surgical site infection (SSI) (3.8% vs. 1.4%; p < 0.001) and a lower rate of organ/space SSI (1.3% vs. 2.9%; p = 0.009). Laparoscopic appendectomy was associated with a shorter LOS in both aggregate and matched cohorts compared with open appendectomy (p < 0.001).

Conclusions

Within ACS NSQIP hospitals, elderly patients benefited from a laparoscopic approach to appendicitis with regards to a shorter LOS and a lower minor and overall morbidity. Laparoscopic appendectomy was associated with lower superficial SSI and higher organ/space SSI rates.

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Disclosures

Drs. Ashkan Moazzez, Rodney J. Mason, and Namir Katkhouda have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Outpatient Surgery, H. Claude Hudson Comprehensive Health Center, Los Angeles, CA, USA

    Ashkan Moazzez

  2. Department of Surgery, University of Southern California, 1100 N. State Str., Room 6A231, Los Angeles, CA, 90033, USA

    Rodney J. Mason & Namir Katkhouda

Authors
  1. Ashkan Moazzez
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  2. Rodney J. Mason
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  3. Namir Katkhouda
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Corresponding author

Correspondence to Rodney J. Mason.

Additional information

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.

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Moazzez, A., Mason, R.J. & Katkhouda, N. Thirty-day outcomes of laparoscopic versus open appendectomy in elderly using ACS/NSQIP database. Surg Endosc 27, 1061–1071 (2013). https://doi.org/10.1007/s00464-012-2557-0

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  • DOI: https://doi.org/10.1007/s00464-012-2557-0

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