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The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the Polish Laparoscopic Appendectomy multicenter large cohort study
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 appendectom...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320074/ https://www.ncbi.nlm.nih.gov/pubmed/30558044 http://dx.doi.org/10.1097/MD.0000000000013621 |
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author | Lasek, Anna Pędziwiatr, Michał Kenig, Jakub Walędziak, Maciej Wysocki, Michał Mavrikis, Judene Myśliwiec, Piotr Bobowicz, Maciej Astapczyk, Kamil Burdzel, Mateusz Chruściel, Karolina Cygan, Rafał Czubek, Wojciech Dowgiałło-Wnukiewicz, Natalia Droś, Jakub Franczak, Paulina Hołówko, Wacław Kacprzyk, Artur Karcz, Wojciech Konrad Konrad, Paweł Kopiejć, Arkadiusz Kot, Adam Krakowska, Karolina Kukla, Maciej Leszko, Agnieszka Łozowski, Leszek Major, Piotr Makarewicz, Wojciech Malinowska-Torbicz, Paulina Matyja, Maciej Michalik, Maciej Niekurzak, Adam Nowiński, Damian Ostaszewski, Radomir Pabis, Małgorzata Polańska-Płachta, Małgorzata Rubinkiewicz, Mateusz Stefura, Tomasz Stępień, Anna Szabat, Paweł Śmiechowski, Rafał Tomaszewski, Sebastian von Ehrlich-Treuenstätt, Victor Wasilczuk, Maciej Wojdyła, Anna Wroński, Jan Wojciech Zwolakiewicz, Leszek |
author_facet | Lasek, Anna Pędziwiatr, Michał Kenig, Jakub Walędziak, Maciej Wysocki, Michał Mavrikis, Judene Myśliwiec, Piotr Bobowicz, Maciej Astapczyk, Kamil Burdzel, Mateusz Chruściel, Karolina Cygan, Rafał Czubek, Wojciech Dowgiałło-Wnukiewicz, Natalia Droś, Jakub Franczak, Paulina Hołówko, Wacław Kacprzyk, Artur Karcz, Wojciech Konrad Konrad, Paweł Kopiejć, Arkadiusz Kot, Adam Krakowska, Karolina Kukla, Maciej Leszko, Agnieszka Łozowski, Leszek Major, Piotr Makarewicz, Wojciech Malinowska-Torbicz, Paulina Matyja, Maciej Michalik, Maciej Niekurzak, Adam Nowiński, Damian Ostaszewski, Radomir Pabis, Małgorzata Polańska-Płachta, Małgorzata Rubinkiewicz, Mateusz Stefura, Tomasz Stępień, Anna Szabat, Paweł Śmiechowski, Rafał Tomaszewski, Sebastian von Ehrlich-Treuenstätt, Victor Wasilczuk, Maciej Wojdyła, Anna Wroński, Jan Wojciech Zwolakiewicz, Leszek |
author_sort | Lasek, Anna |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6320074 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-63200742019-01-14 The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the Polish Laparoscopic Appendectomy multicenter large cohort study Lasek, Anna Pędziwiatr, Michał Kenig, Jakub Walędziak, Maciej Wysocki, Michał Mavrikis, Judene Myśliwiec, Piotr Bobowicz, Maciej Astapczyk, Kamil Burdzel, Mateusz Chruściel, Karolina Cygan, Rafał Czubek, Wojciech Dowgiałło-Wnukiewicz, Natalia Droś, Jakub Franczak, Paulina Hołówko, Wacław Kacprzyk, Artur Karcz, Wojciech Konrad Konrad, Paweł Kopiejć, Arkadiusz Kot, Adam Krakowska, Karolina Kukla, Maciej Leszko, Agnieszka Łozowski, Leszek Major, Piotr Makarewicz, Wojciech Malinowska-Torbicz, Paulina Matyja, Maciej Michalik, Maciej Niekurzak, Adam Nowiński, Damian Ostaszewski, Radomir Pabis, Małgorzata Polańska-Płachta, Małgorzata Rubinkiewicz, Mateusz Stefura, Tomasz Stępień, Anna Szabat, Paweł Śmiechowski, Rafał Tomaszewski, Sebastian von Ehrlich-Treuenstätt, Victor Wasilczuk, Maciej Wojdyła, Anna Wroński, Jan Wojciech Zwolakiewicz, Leszek Medicine (Baltimore) Research Article 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. Wolters Kluwer Health 2018-12-14 /pmc/articles/PMC6320074/ /pubmed/30558044 http://dx.doi.org/10.1097/MD.0000000000013621 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 |
spellingShingle | Research Article Lasek, Anna Pędziwiatr, Michał Kenig, Jakub Walędziak, Maciej Wysocki, Michał Mavrikis, Judene Myśliwiec, Piotr Bobowicz, Maciej Astapczyk, Kamil Burdzel, Mateusz Chruściel, Karolina Cygan, Rafał Czubek, Wojciech Dowgiałło-Wnukiewicz, Natalia Droś, Jakub Franczak, Paulina Hołówko, Wacław Kacprzyk, Artur Karcz, Wojciech Konrad Konrad, Paweł Kopiejć, Arkadiusz Kot, Adam Krakowska, Karolina Kukla, Maciej Leszko, Agnieszka Łozowski, Leszek Major, Piotr Makarewicz, Wojciech Malinowska-Torbicz, Paulina Matyja, Maciej Michalik, Maciej Niekurzak, Adam Nowiński, Damian Ostaszewski, Radomir Pabis, Małgorzata Polańska-Płachta, Małgorzata Rubinkiewicz, Mateusz Stefura, Tomasz Stępień, Anna Szabat, Paweł Śmiechowski, Rafał Tomaszewski, Sebastian von Ehrlich-Treuenstätt, Victor Wasilczuk, Maciej Wojdyła, Anna Wroński, Jan Wojciech Zwolakiewicz, Leszek The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the Polish Laparoscopic Appendectomy multicenter large cohort study |
title | The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the Polish Laparoscopic Appendectomy multicenter large cohort study |
title_full | The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the Polish Laparoscopic Appendectomy multicenter large cohort study |
title_fullStr | The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the Polish Laparoscopic Appendectomy multicenter large cohort study |
title_full_unstemmed | The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the Polish Laparoscopic Appendectomy multicenter large cohort study |
title_short | The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the Polish Laparoscopic Appendectomy multicenter large cohort study |
title_sort | significant impact of age on the clinical outcomes of laparoscopic appendectomy: results from the polish laparoscopic appendectomy multicenter large cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320074/ https://www.ncbi.nlm.nih.gov/pubmed/30558044 http://dx.doi.org/10.1097/MD.0000000000013621 |
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