Laparoscopic appendectomy provides better outcomes than open appendectomy in elderly patients

Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan.
The American surgeon (Impact Factor: 0.82). 04/2011; 77(4):466-70.
Source: PubMed


The incidence of acute appendicitis in elderly patients is increasing due to prolonged life span. The associated morbidity and mortality related to perforation of acute appendicitis continue to present challenges to physicians. The role of laparoscopic appendectomy is still controversial. This study aimed to compare the postoperative outcomes of elderly patients who received either a laparoscopic or an open appendectomy. We retrospectively reviewed charts of patients with acute appendicitis between January 2005 and February 2009. Elderly patients who received laparoscopic or open appendectomies were enrolled. The demographics, preoperative condition, operating time, intraoperative blood loss, and postoperative course were analyzed. A total of 150 patients were enrolled in this study. On average, patients who received a laparoscopic appendectomy had fewer hospital days and lower rates of postoperative ventilator dependence than patients who received an open appendectomy. In the management of elderly patients with acute appendicitis, laparoscopic appendectomy provides better outcomes than open appendectomy.

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    ABSTRACT: To determine if results for laparoscopic appendectomy for complicated appendicitis have improved with 15 years of experience and advances in technology. A retrospective review of 169 patients who underwent laparoscopic appendectomy in 2009 was performed. Of these, the 25 who were identified with gangrenous appendicitis and the 25 with perforated appendicitis served as our study population. These patients were compared with 15 patients with gangrenous appendicitis and 19 patients with perforated appendicitis from 1995 who had undergone laparoscopic appendectomy to determine if improvements in patient outcome have coincided with improvements in experience and technology. Patient demographics, operating time, length of hospitalization, and complications were compared and analyzed for statistical significance. The two groups were similar regarding age and sex distribution. Operating time was unchanged between the two study times. A significant improvement was seen in length of stay and a trend toward fewer infectious complications in the later study group. Experience and advances in medical technology have translated into improved results for laparoscopic appendectomy for complicated appendicitis.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2012; 22(6):581-3. DOI:10.1089/lap.2011.0419 · 1.34 Impact Factor
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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.
    Surgical Endoscopy 10/2012; 27(4). DOI:10.1007/s00464-012-2557-0 · 3.26 Impact Factor
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    ABSTRACT: Mounting evidence supports the use of laparoscopic techniques for the treatment of simple appendicitis. However, most of the advantages of these techniques are of limited clinical relevance. This study compares the treatment outcomes of laparoscopic appendectomies and open appendectomies performed in Taiwan. This study uses data from the 2007 to 2009 Taiwan National Health Insurance Research Database. The study sample included 65,339 patients, hospitalized with a discharge diagnosis of acute appendicitis (33.8% underwent laparoscopic appendectomy). A generalized estimated equation (GEE) was performed to explore the relationship between the use of laparoscopy and 30-day re-admission. Hierarchical linear regressions were performed to examine the relationship between the use of laparoscopy, the length of stay (LOS), and the cost per discharge. A significantly lower proportion of patients undergoing laparoscopic appendectomies were re-admitted within 30 days of their index appendectomy, in comparison to patients undergoing open appendectomies (0.66% versus 1.925, p<0.001). Compared with patients undergoing open appendectomies, patients undergoing laparoscopic appendectomies had a shorter LOS (4.01 versus 5.33 days, p<0.001) and a higher cost per discharge (NT$40,554 versus NT$38,509, p<0.001. In 2007, the average exchange rate was US$1 = NT$31.0). GEE revealed that the odds ratio of 30-day readmission for patients undergoing laparoscopic appendectomy was 0.38 (95% CI = 0.33-0.46) that of patients undergoing open appendectomies, after adjusting for surgeon, hospital, and patient characteristics, as well as for the clustering effect of particular surgeons and the propensity score. This study found that laparoscopic appendectomies had a lower 30-day re-admission rate, and a shorter LOS, but a slightly higher cost per discharge than open appendectomies.
    PLoS ONE 07/2013; 8(7):e68662. DOI:10.1371/journal.pone.0068662 · 3.23 Impact Factor
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