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Advantages of Laparoscopic Appendectomy in the Elderly of North Carolina
Andrew Harrell, Yuri Novitsky, Amy Lincourt, Michael Rosen, Kent Kercher, B. Todd Heniford, Carolinas Medical Center, Charlotte, NC

Background:
Laparoscopic appendectomy (LA) has been gaining in popularity in recent years. However, the benefits of LA in the elderly population are not well established. We hypothesized that LA in the elderly may have distinctive advantages in perioperative outcomes over open appendectomy (OA).

Methods:
We queried the 1997-2003 North Carolina Hospital Association Patient Data System for all patients with the primary ICD-9 procedure code for appendectomy and listed as non-elective cases (emergent or urgent). The patients were separated into adult (age 18-64) and elderly (> 65 years), and open versus laparoscopic. Outcomes including length of stay, total charges, complications, and death were analyzed.

Results:
From 1997 to 2003 there were 28,929 appendectomies performed for adult patients, and 3009 in the elderly. The annual frequency of LA performed in the elderly increased from 1997 to 2003 (10.6% to 21.0%, p<0.05). For both LA and OA, elderly patients had a longer length of stay (LOS) (7.2 vs. 3.5 days, p=0.0001), higher total charges ($19,869 vs. $11,160, p=0.0001), more complications (22.1% vs. 9.0%, p=0.0001) and a higher mortality rate (2.26% vs. 0.15%, p=0.0001) when compared to the adult patients. When compared to OA, elderly patients undergoing LA had a shorter LOS (4.6 vs. 7.8, p=0.0001), lower total charges ($16,671 vs. $20,598, p=0.003), fewer complications (14.4% vs. 23.8%, p=0.0001), and a lower mortality rate (0.4% vs. 2.7%, p=0.0009). When elderly patients that underwent LA were compared to the adult patients, they had higher total charges ($16,670 vs. $11,160, p=0.0001) but equivalent mortality (0.37% vs. 0.15%, p=0.20).

Conclusions:
Appendectomy in the elderly is associated with higher rates of morbidity, mortality and total charges as compared to adult patients. The utilization of LA in the elderly has significantly increased in recent years. The laparoscopic approach to appendectomy in the elderly patient has advantages over OA in terms of decreased LOS, lower total charges, a lower complication rate, and a lower mortality. Although more expensive, LA in the elderly decreases mortality to equal that of younger adults. Laparoscopy may be the preferred approach in elderly patients who require urgent or emergent appendectomy.


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