Outcomes of Acute Appendicitis in Elderly Patients: a Single Center Analysis of 2000 Laparoscopic Appendectomies
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RESEARCH COMMUNICATION
Outcomes of Acute Appendicitis in Elderly Patients: a Single Center Analysis of 2000 Laparoscopic Appendectomies Cristian A. Angeramo 1 & Nicolas H. Dreifuss 1 & Julieta Giacone 1 & Francisco Schlottmann 1 Received: 15 June 2020 / Accepted: 28 June 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Laparoscopic appendectomy . Acute appendicitis . Elderly . Outcomes
Introduction Acute appendicitis (AA) remains the most common indication for emergent surgery. Despite the peak incidence occurs in the second decade of life, approximate1 ly 5–10% of all AA develops in the elderly population. As the world’s elderly population is growing, the incidence of AA in old individuals will increase in the 2 upcoming years. We aimed to determine the surgical outcomes of laparoscopic appendectomy (LA) in elderly patients analyzing a large cohort of patients with AA operated at our institution.
Methods Data were collected prospectively from all patients who underwent LA between 2006 and 2019. Patients were stratified into two groups: patients ≥ 65 years (G1) and patients < 65 years (G2). Pre-, intra-, and postoperative variables were assessed and compared. Complicated appendicitis was defined as perforation of the appendix, gangrene, empyema, or abscess formation. Purulent fluid localized in one or more quadrants was defined as peritonitis. The Student’s t test and the χ2 test were used to compare continuous and categorical variables, respectively. A logistic regression analysis was performed to
* Francisco Schlottmann [email protected] 1
Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640 (C1118AAT), Buenos Aires, Argentina
determine the effect of age, as a continuous variable, on surgical outcomes.
Results A total of 2009 LA were performed; 122 (6%) were included in G1 and 1887 (94%) in G2. Complicated appendicitis and presence of peritonitis were significantly more frequent among elderly individuals. Overall morbidity (G1: 30% vs. G2: 14%, p < 0.0001) and postoperative intra-abdominal abscess (IAA) rates (G1: 7% vs. 2%, p = 0.0004) were higher in G1. Mean length of hospital stay was longer (G1: 3.4 days vs. G2:1.6 days, p < 0.001) in G1 (Table 1). Age was a risk factor for complicated appendicitis (OR 1.04, 95% CI 1.03–1.05), presence of peritonitis (OR 1.03, 95% CI 1.02–1.04), and postoperative IAA (OR 1.03, 95% CI 1.02–1.05). The odds of overall morbidity increased with age 2% per year (OR 1.02, 95% CI 1.01–1.03) (Fig. 1).
Discussion Life expectancy is lengthening almost linearly in most developed countries. These changes might have an impact on AA epidemiology. In fact, it has been shown that AA incidence has decreased in the group of peak incidence (10–19 years old) and increased by 6.3% in 2 individuals between 30 and 69 years old. In our institution, the incidence of AA in patients over 65 years old was 6%. Delay in consultation may partially explain the higher 1 incidence of appendiceal perforation among elderly. ,3
J Gastrointest Sur
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