title: Value of laparoscopic appendectomy in the elderly patient.
abstract: BACKGROUND
  Acute appendicitis (AA) in elderly patients (60 years of age and older) is a challenging problem associated with significant morbidity and mortality when perforation is present. We hypothesized that laparoscopic appendectomy (LA) would enable an earlier correct diagnosis and have advantages in elderly patients.
  
  
  METHODS
  We performed a retrospective review of patients who underwent laparoscopic appendectomy for suspected AA. Data of elderly patients were compared to data of younger patients (18 to <60 years of age).
  
  
  RESULTS
  Fifty-four LA were performed in elderly patients and 423 in younger patients. Patients over the age of 60 years had more co-morbidities and required more frequent use of anticoagulants. Preoperative imaging (ultrasound or computerized tomography) was significantly more frequent in elderly patients (36% versus 15%), and was associated with a higher rate of confirmation of acute appendicitis (78% versus 55%), which allowed a decrease in the rate of negative surgical explorations to 4.1% in elderly patients compared to 10.2% in younger patients. Complicated appendicitis and conversions were more frequent in the elderly patients. This resulted in prolonged operative time and longer hospital stay for this group. The overall complication rate was equivalent in the two groups, without differences in the occurrence either of infectious complications or of complications related to surgical site. There were no deaths following appendectomy in our series.
  
  
  CONCLUSIONS
  Laparoscopic appendectomy is safe in the elderly population and is not associated with any increase in morbidity. The high incidence of complicated appendicitis in elderly patients affects operative time and length of hospital stay following laparoscopic appendectomy, and it can also lead to an increased rate of conversion to an open procedure. Use of preoperative abdominal computerized tomography scan is mandatory in elderly patients to provide an early diagnosis and to decrease unnecessary surgical exploration when acute appendicitis is suspected.
authors.affiliation: Department of Surgery "A", Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel. orkirsh@bgu.ac.il
authors.forename: Boris
authors.initials: B
authors.lastname: Kirshtein
authors.forename: Zvi Howard
authors.initials: ZH
authors.lastname: Perry
authors.forename: Solly
authors.initials: S
authors.lastname: Mizrahi
authors.forename: Leonid
authors.initials: L
authors.lastname: Lantsberg
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014463:Ultrasonography / Q000706:statistics & numerical data
chemical_list: D000925:Anticoagulants