title: Laparoscopic appendectomy is safe and efficacious for the elderly: an analysis using the National Surgical Quality Improvement Project database.
abstract: BACKGROUND
  Despite increasing use of laparoscopic appendectomy, data demonstrating outcomes of this technique exclusively among the elderly population are scarce. This study aimed to compare 30-day postoperative morbidity and length of hospital stay among elderly patients after appendectomy.
  
  
  METHODS
  Appendicitis patients older than 65 years were extracted from the National Surgical Quality Improvement Project (NSQIP) database. Demographics and rates of complications for patients undergoing open and laparoscopic appendectomies were compared. Uni- and multivariate analyses adjusted for differences between groups compared the end points of major and minor complications as well as the days of hospital stay after initial surgery.
  
  
  RESULTS
  A total of 3,335 patients underwent appendectomy, with 2,235 patients (67%) receiving a laparoscopic procedure. The open appendectomy patients were significantly older and more likely to have various preoperative comorbidities (p<0.05). No difference in median operative time between the two techniques was found. Both required 51 min (p=0.11). The open cases had higher rates of both major and minor postoperative complications than the laparoscopic cases (p<0.0001), both overall and before discharge. Multivariate analysis showed no association between operative approach and major complications, and a reduced risk of minor complications with laparoscopy. Length of surgical stay was longer for the open group than for the laparoscopically treated group (median, 4 days vs 2 days; p<0.05). After adjustment, laparoscopy still was significantly associated with a shorter hospital stay than open appendectomy (p<0.0001).
  
  
  CONCLUSIONS
  Laparoscopic appendectomy is a safe procedure for elderly patients. During the 30-day postoperative period, no correlation with major complications was found, and the findings showed a beneficial association with regard to minor complications. After adjustment for perioperative factors, laparoscopy is associated with a shorter hospital stay than open appendectomy.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University of Rochester, Rochester, NY, USA. michael_kim@urmc.rochester.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kim
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Gunzler
authors.forename: Susan
authors.initials: S
authors.lastname: Messing
authors.forename: Rabih M
authors.initials: RM
authors.lastname: Salloum
authors.forename: John R T
authors.initials: JR
authors.lastname: Monson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D058996:Quality Improvement; D016896:Treatment Outcome