Division of Colorectal Surgery, Department of Surgery, University of Rochester, Rochester, NY, USA.
Surg Endosc. 2011 Jun;25(6):1802-7. doi: 10.1007/s00464-010-1467-2. Epub 2011 Feb 7.
Despite increasing use of laparoscopic appendectomy, data demonstrating outcomes of this technique exclusively among the elderly population are scarce. This study aimed to compare 30-day postoperative morbidity and length of hospital stay among elderly patients after appendectomy.
Appendicitis patients older than 65 years were extracted from the National Surgical Quality Improvement Project (NSQIP) database. Demographics and rates of complications for patients undergoing open and laparoscopic appendectomies were compared. Uni- and multivariate analyses adjusted for differences between groups compared the end points of major and minor complications as well as the days of hospital stay after initial surgery.
A total of 3,335 patients underwent appendectomy, with 2,235 patients (67%) receiving a laparoscopic procedure. The open appendectomy patients were significantly older and more likely to have various preoperative comorbidities (p<0.05). No difference in median operative time between the two techniques was found. Both required 51 min (p=0.11). The open cases had higher rates of both major and minor postoperative complications than the laparoscopic cases (p<0.0001), both overall and before discharge. Multivariate analysis showed no association between operative approach and major complications, and a reduced risk of minor complications with laparoscopy. Length of surgical stay was longer for the open group than for the laparoscopically treated group (median, 4 days vs 2 days; p<0.05). After adjustment, laparoscopy still was significantly associated with a shorter hospital stay than open appendectomy (p<0.0001).
Laparoscopic appendectomy is a safe procedure for elderly patients. During the 30-day postoperative period, no correlation with major complications was found, and the findings showed a beneficial association with regard to minor complications. After adjustment for perioperative factors, laparoscopy is associated with a shorter hospital stay than open appendectomy.
尽管腹腔镜阑尾切除术的应用越来越广泛，但专门针对老年人群的数据却很少。本研究旨在比较老年人阑尾切除术后 30 天内的术后发病率和住院时间。
从国家手术质量改进计划（NSQIP）数据库中提取年龄大于 65 岁的阑尾炎患者。比较开腹和腹腔镜阑尾切除术患者的人口统计学和并发症发生率。通过单变量和多变量分析，比较主要和次要并发症的终点以及初次手术后住院天数，调整组间差异。
共有 3335 例患者接受阑尾切除术，其中 2235 例（67%）接受腹腔镜手术。开腹阑尾切除术患者年龄明显较大，且术前合并症更多（p<0.05）。两种手术的中位手术时间无差异。均需 51 分钟（p=0.11）。开放组的主要和次要术后并发症发生率均高于腹腔镜组（p<0.0001），总体和出院前均如此。多变量分析显示手术方式与主要并发症之间无关联，而腹腔镜手术可降低轻微并发症的风险。开放组的手术住院时间长于腹腔镜组（中位数，4 天比 2 天；p<0.05）。调整后，腹腔镜与开腹阑尾切除术相比，住院时间仍明显缩短（p<0.0001）。
腹腔镜阑尾切除术是老年患者安全的手术方法。在术后 30 天内，未发现与主要并发症相关，且发现与轻微并发症有有益的关联。调整围手术期因素后，与开腹阑尾切除术相比，腹腔镜与较短的住院时间相关。
