CHICAGO — A laparoscopic approach to appendectomy in the elderly appears to reduce mortality and complications, Dr. Andrew Harrell said at the annual meeting of the Society for Surgery of the Alimentary Tract.
Using data from the North Carolina Hospital Association Patient Data System, Dr. Harrell and his colleagues analyzed results for all patients who had an ICD-9 code for appendectomy in 1997–2003 who were either urgent or emergent. They then compared outcomes for patients aged 18–64 years and those aged 65 and over, and for those who had open and laparoscopic procedures.
During the time period analyzed, there were 28,929 appendectomies in the younger age group and 3,009 in the older group. Use of the laparoscopic approach in people over age 65 increased from 10.6% of appendectomies in 1997 to 21% in 2003, said Dr. Harrell of the division of gastrointestinal and minimally invasive surgery at the Carolinas Medical Center in Charlotte, N.C.
The elderly had a longer length of stay in the hospital (7.2 days vs. 3.5 days for the younger group), regardless of whether the procedure was open or laparoscopic. Complication rates and death rates were also higher in the elderly than in younger patients: 22.1% vs. 9% and 2.2% vs. 0.15%, respectively.
But, when older patients underwent laparoscopic appendectomy, all the outcomes improved, said Dr. Harrell. The length of stay decreased to 4.6 days, and 14.4% experienced complications, compared with 23.8% of those undergoing the open procedure. Mortality declined to 0.4% for the laparoscopic approach, compared with 2.7% for the open procedure. Laparoscopic charges, however, were higher than those for the younger group's less invasive surgery, at $16,670 compared with $11,160.
Dr. John Hunter, chairman of surgery at Oregon Health and Science University, Portland, said that although the data were intriguing, he found many flaws in the analysis. The patients who had laparoscopy appeared to be younger, healthier, and predominantly female, said Dr. Hunter, who discussed the paper at the meeting.
This imbalance seems to make direct comparisons between the groups difficult, Dr. Hunter said.
Dr. Harrell said that he and his colleagues did notice a difference, but a subset and a multivariate analysis (controlling for age, gender, and comorbidities) still showed significantly shorter hospitalizations for the laparoscopic group and a higher rate of routine discharge to the patient's home, when compared with the open surgery group.