title: Does laparoscopic appendectomy impart an advantage over open appendectomy in elderly patients?
abstract: BACKGROUND
  The use of laparoscopy in the elderly has been increasing in recent years. The data comparing laparoscopic (LA) with open appendectomy (OA) in elderly patients are minimal. We evaluated outcomes of LA versus OA in perforated and nonperforated appendicitis in elderly patients (aged ≥ 65 years).
  
  
  METHODS
  Using the Nationwide Inpatient Sample database, clinical data of elderly patients who underwent LA and OA for suspected acute appendicitis were evaluated from 2006 to 2008.
  
  
  RESULTS
  A total of 65,464 elderly patients underwent urgent appendectomy during this period. The rate of perforated appendicitis was twice as high in elderly patients (50 vs. 25%, p < 0.01) and rate of LA in elderly patients was lower (52 vs. 63%, p < 0.01) compared with patients younger than aged 65 years. Utilization of LA increased 24% from 46.5% in 2006 to 57.8% in 2008 (p < 0.01). In elderly patients with acute nonperforated appendicitis, LA had lower overall complication rate (15.82 vs. 23.49%, p < 0.01), in-hospital mortality (0.39 vs. 1.31%, p < 0.01), hospital charges ($30,414 vs. $34,095, p < 0.01), and mean length of stay (3.0 vs. 4.8 days, p < 0.01) compared with OA. Additionally, in perforated appendicitis in elderly patients, LA was associated with lower overall complication rate (36.27 vs. 46.92%, p < 0.01), in-hospital mortality (1.4 vs. 2.63%, p < 0.01), mean hospital charges ($43,339 vs. $57,943, p < 0.01), and shorter mean LOS (5.8 vs. 8.7 days, p < 0.01).
  
  
  CONCLUSIONS
  Laparoscopic appendectomy can be performed safely with significant advantages compared with open appendectomy in the elderly and should be considered the procedure of choice for perforated and nonperforated appendicitis in these patients.
authors.affiliation: Department of Surgery, University of California, Irvine Medical Center, 333 City Blvd. West Suite 700, Orange, CA 92868, USA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Masoomi
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Dolich
authors.forename: Noor
authors.initials: N
authors.lastname: Ketana
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000191:economics / Q000601:surgery*; D005260:Female; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007416:Intestinal Perforation / Q000191:economics / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics; D008297:Male; D011183:Postoperative Complications; D012044:Regression Analysis; D016896:Treatment Outcome