Safe laparoscopic surgery in the elderly.
BACKGROUND
The elderly are more prone to complications of surgery because of comorbidity, and they may benefit most from a minimally invasive approach. This study was intended to evaluate the safety of the use of a laparoscopic approach for emergency and elective surgery in elderly patients.


METHODS
From January 2000 to June 2001, all patients over 75 years of age who underwent a procedure that began laparoscopically were included. Physiologic and operative scores according to the POSSUM scoring system were recorded. These were then used to calculate predicted morbidity and mortality by both the POSSUM and P-POSSUM systems. Predicted outcomes were compared with actual outcomes.


RESULTS
One hundred sixty-two patients with a mean age of 80 years were included; 52% were emergency cases. The overall morbidity was 14.5% and the mortality rate was 1.8%. Fourteen procedures (8.4%), all emergencies, were converted. Both mortality and morbidity rates were lower than the predicted values (P = 0.001 and P = 0.0001, respectively).


CONCLUSIONS
A laparoscopic approach can be used safely in an elderly population undergoing surgery in a daily practice for miscellaneous conditions, whether elective or emergency operations.
IRCAD/EITS, European Institute of Telesurgery, University Louis Pasteur, 1, Place de l'Hôpital, 67091 Strasbourg, France. jacques.marescaux@ircad.u-strasbg.fr
Robrecht
R
Ceulemans
Nasr
N
Al-Ahdab
Joel
J
Leroy
Alain
A
Garcia
Erik
E
Dutson
Francesco
F
Rubino
Michele
M
Simone
Didier
D
Mutter
Jacques
J
Marescaux
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality*; D008297:Male; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome