Is appendectomy safe for elderly patients?
It is estimated that by 2030, 20% of Americans will be old (65 years or older). This means that the number of elderly surgical patients will increase significantly. In terms of appendicitis, compared with younger patients, elderly patients usually have more comorbidities, and symptoms of acute appendicitis may be delayed.
Shannon's team from the University of California, USA, used data from the National Surgical Quality Improvement Program database of the American College of Surgeons to conduct a statistical analysis to assess the difference in outcomes between elderly patients and young patients undergoing appendectomy.
The researchers searched the ACS National Surgical Quality Improvement Program appendectomy database to find patients who were 18 years of age or older with preoperative imaging findings consistent with acute appendicitis from 2016 to 2017.
At the same time, the researchers compared elderly patients (age ≥ 65 years old) with young patients (aged <65 years old) in the following aspects: intraoperative perforation with or without abscess, conversion to laparotomy, postoperative intra-abdominal abscess, and 30-day re-admission Incidence rate, total length of stay (LOS) and discharge destination.
The results of the study showed that of 21,586 patients undergoing appendectomy, 2,060 were elderly patients. Compared with young people, elderly patients are less likely to have leukocytosis (59.0% vs. 65.8%), and the final pathological results show a higher probability of attachment tumors (2.0% vs. 0.8%).
At the same time, the conversion from unplanned laparoscopic surgery to open surgery and 30-day readmissions are also more frequent. In addition, elderly patients have a longer median hospital stay (2 days vs. 1 day).
Compared with young people, elderly patients had an increased risk of intraoperative perforation with or without abscess and postoperative intra-abdominal abscess, but there was no difference in the associated risk of death.
In summary, this study shows that nearly 10% of laparoscopic appendectomy patients are elderly patients.Compared with younger patients, the proportion of elderly patients who converted to open surgery in the final laparoscopic surgery, the proportion of pathological findings as tumors, and the risk of postoperative perforation with or without abscess, intraoperative perforation and/or abscess, and postoperative intra-abdominal abscess Both are higher, but the risk of death is similar.
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