Laparoscopic appendectomy is safer than open appendectomy in an elderly population

Abstract

Background and objectives: This study describes perioperative patient safety outcomes comparing laparoscopic appendectomy with open appendectomy in the elderly population (defined as age≥65 years) during the diffusion of laparoscopic appendectomy into widespread clinical practice.

Methods: We performed a cross-sectional analysis of patients undergoing open or laparoscopic appendectomy in the US Nationwide Inpatient Sample, a 20% sample of inpatient discharges from 1056 hospitals, from 1998 to 2009, and used weighted sampling to estimate national trends. Multivariate logistic regression modeling was used to examine the association of laparoscopy with perioperative outcomes.

Results: Patients who met the inclusion criteria totaled 257,484. Of these, 87,209 (34%) underwent laparoscopic appendectomy. These patients were younger (P<.001); had lower Charlson comorbidity scores (P<.001); were more likely to be white (P<.001), to be privately insured (P=.005), and to undergo surgery in urban hospitals (P<.001); and were less likely to have appendiceal rupture (P<.001). Laparoscopic appendectomy was associated with a decreased length of stay (4.44 days vs 7.86 days, P<.001), fewer total patient safety indicator events (1.8% vs 3.5%, P<.001), and a decreased mortality rate (0.9% vs 2.8%, P<.001). On multivariate analyses, we observed a 32% (odds ratio, 0.68) decreased probability of patient safety events occurring in laparoscopic appendectomy cases versus open appendectomy cases as measured by patient safety indicators.

Conclusion: The data suggest that laparoscopic appendectomy is associated with improved clinical outcomes in the elderly and that diffusion of laparoscopic appendectomy is not associated with adverse patient safety events in this population.

Keywords: Appendectomy; Patient safety indicator; Surgery in elderly.

Figure 1.

Appendectomy by year (NIS, age ≥65 years, 1998–2009).

Figure 2.

Proportion appendectomy performed laparoscopically by year (NIS, age ≥65 years, 1998–2009).