RT Journal
A1 Southgate E, Vousden N, Karthikesalingam A, Markar SR, Black S, Zaidi A
T1 LAparoscopic vs open appendectomy in older patients
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD June 1
VO 147
IS 6
SP 557
OP 562
DO 10.1001/archsurg.2012.568
UL http://dx.doi.org/10.1001/archsurg.2012.568
AB Hypothesis 
                  The results of a meta-analysis of individual studies comparing laparoscopic vs open appendectomy in older patients may guide the choice of surgical approach.Design 
                  Meta-analysis.Setting 
                  Academic research.Patients 
                  MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for comparative studies of older patients with a diagnosis of acute appendicitis.Main Outcome Measures 
                  Primary outcomes were postoperative mortality and overall morbidity. Secondary outcomes were operative time, length of hospital stay, postoperative wound infection, and intra-abdominal collection. Using the lowest threshold from the articles included, older patients were defined as those older than 60 years.Results 
                  
            Analyzed were 6 studies comprising 15 852 appendectomies (4398 laparoscopic and 11 454 open procedures). Laparoscopic appendectomy was associated with significant reductions in postoperative mortality (pooled odds ratio, 0.24; 95% CI, 0.15-0.37), postoperative complications (pooled odds ratio, 0.61; 95% CI, 0.50-0.73), and length of hospital stay (weighted mean difference, −0.51 days; 95% CI, −0.64 to −0.37 days) (P < .05 for all). No significant group differences were observed in operative time, postoperative wound infection, or intra-abdominal collection.
          Conclusions 
                  In older patients, laparoscopic appendectomy is associated with reduced postoperative mortality and morbidity, although randomized data are required to infer causality. A health economic analysis with quality-of-life metrics is needed to investigate potential benefits of the reduced length of hospital stay observed following laparoscopic appendectomy in this cohort.