The significant impact of age on the clinical outcomes of laparoscopic appendectomy

Abstract

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults.Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1—<40 years old; Group 2—between 40 and 64 years old; Group 3—between 65 and 74 years old; and Group 4—75 years old or older. Groups were compared in terms of peri- and postoperative outcomes.The ratio of complicated appendicitis grew with age (20.97% vs 37.50% vs 43.97% vs 56.84%, P < .001). Similarly, elderly patients more frequently suffered from perioperative complications (5.06% vs 9.3% vs 10.88% vs 13.68%, P < .001) and had the longest median length of stay (3 [Interquartile Range (IQR) 2–4] vs 3 [IQR 3–5], vs 4 [IQR 3–5], vs 5 [IQR 3–6], P < .001) as well as the rate of patients with prolonged length of hospital stay (LOS) >8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48 hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days).The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome.

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

“…A study was performed over a 6-month period involving 18 Polish and German surgical centers. A database compiled the data of patients admitted for acute appendicitis 9 . The local team of nurses, anesthesiologists, and assistants along with the coordinating surgeon acquired data in each participating surgical unit.…”

Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem

“…The prevalence of complicated appendicitis increases with age: 13.6–20.97% in patients younger than 40 [ 5 , 11 , 39 ], 37.5% in those aged 40–64 years [ 39 ], 43.97% in those aged 65–74 [ 39 ], and 56.84–63.0% in those aged above 75 [ 5 , 39 ], with an even bigger increase after age of 80 (64.9–72.7%) [ 12 , 13 ].…”

“…Increased morbidity is reflected in mean length of stay in hospital (LOS, 4.0–6.0 days) [ 12 , 31 , 39 , 62 ]. This increases to 7.8–11 days [ 12 , 62 ] in patients above the age of 80 as compared to 2.6–3.2 days [ 12 , 31 ] in the younger population.…”

Evaluation of some cellular biomarker proteins, oxidative stress and clinical indices as results of laparoscopic appendectomy for perforated appendicitis in children

“…At present, laparoscopic appendectomy is mostly used to treat acute appendicitis clinically. Compared with open access, it has faster recovery speed and shorter length of stay (7). Laparoscopic surgery is a minimally invasive surgery, which is mainly operated by visualization and two-dimensional video obtained by transferring endoscope to body cavity on the screen.…”