Portal de Periódicos da CAPES

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

2018; Wolters Kluwer; Volume: 97; Issue: 50 Linguagem: Inglês

10.1097/md.0000000000013621

1536-5964

Anna Lasek, Michał Pędziwiatr, Jakub Kenig, Maciej Wałędziak, Michał Wysocki, Judene Mavrikis, Piotr Myśliwiec, Maciej Bobowicz, Kamil Astapczyk, Mateusz Burdzel, Karolina Chruściel, Rafał Cygan, Wojciech Czubek, Natalia Dowgiałło‐Gornowicz, Jakub Droś, Paula Franczak, Wacław Hołówko, Artur Kacprzyk, Wojciech Konrad Karcz, Paweł Konrad, Arkadiusz Kopiejć, Adam Kot, Karolina Krakowska, Maciej Kukla, Agnieszka Leszko, Leszek Łozowski, Piotr Major, Wojciech Makarewicz, Paulina Malinowska-Torbicz, Maciej Matyja, Maciej Michalik, Adam Niekurzak, Damian Nowiński, Radomir Ostaszewski, Małgorzata Pabis, Małgorzata Polańska-Płachta, Mateusz Rubinkiewicz, Tomasz Stefura, Anna Stępień, Paweł Szabat, Rafał Śmiechowski, Sebastian Tomaszewski, Victor von Ehrlich-Treuenstätt, Maciej Wasilczuk, Anna Wojdyła, Jan Wojciech Wroński, Leszek Zwolakiewicz,

Intraperitoneal and Appendiceal Malignancies

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.