Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study.
Acute appendicitis
Appendectomy
Elderly
Frail patients
Postoperative complications
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
28
03
2019
accepted:
08
07
2019
pubmed:
17
7
2019
medline:
15
12
2021
entrez:
17
7
2019
Statut:
ppublish
Résumé
A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65 years. Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy. Between January 2017 and June 2018, 135 patients aged ≥ 65 years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61-0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12-3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11-6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05-3.89). In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.
Sections du résumé
BACKGROUND
BACKGROUND
A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65 years.
METHODS
METHODS
Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy.
RESULTS
RESULTS
Between January 2017 and June 2018, 135 patients aged ≥ 65 years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61-0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12-3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11-6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05-3.89).
CONCLUSIONS
CONCLUSIONS
In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.
Identifiants
pubmed: 31309237
doi: 10.1007/s00068-019-01186-2
pii: 10.1007/s00068-019-01186-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1729-1737Investigateurs
F Agresta
(F)
G Alemanno
(G)
G Anania
(G)
M Antropoli
(M)
G Argenio
(G)
J Atzeni
(J)
N Avenia
(N)
A Azzinnaro
(A)
G Baldazzi
(G)
G Balducci
(G)
G Barbera
(G)
G Bellanova
(G)
C Bergamini
(C)
L Bersigotti
(L)
P P Bianchi
(PP)
C Bombardini
(C)
G Borzellino
(G)
S Bozzo
(S)
G Brachini
(G)
G M Buonanno
(GM)
T Canini
(T)
S Cardella
(S)
G Carrara
(G)
D Cassini
(D)
M Castriconi
(M)
G Ceccarelli
(G)
D Celi
(D)
M Ceresoli
(M)
M Chiarugi
(M)
N Cillara
(N)
F Cimino
(F)
L Cobuccio
(L)
G Cocorullo
(G)
E Colangelo
(E)
G Costa
(G)
A Crucitti
(A)
P Dalla Caneva
(P)
M De Luca
(M)
A De Manzoni Garberini
(A)
C De Nisco
(C)
M De Prizio
(M)
A De Sol
(A)
A Dibella
(A)
T Falcioni
(T)
N Falco
(N)
C Farina
(C)
E Finotti
(E)
T Fontana
(T)
G Francioni
(G)
P Fransvea
(P)
B Frezza
(B)
G Garulli
(G)
M Genna
(M)
S Giannessi
(S)
A Gioffrè
(A)
A Giordano
(A)
D Gozzo
(D)
S Grimaldi
(S)
G Gulotta
(G)
V Iacopini
(V)
T Iarussi
(T)
E Laterza
(E)
A Leonardi
(A)
L Lepre
(L)
L Lorenzon
(L)
G Luridiana
(G)
A Malagnino
(A)
G Mar
(G)
P Marini
(P)
R Marzaioli
(R)
G Massa
(G)
V Mecarelli
(V)
A Mingoli
(A)
G Nigri
(G)
S Occhionorelli
(S)
N Paderno
(N)
G M Palini
(GM)
D Paradies
(D)
M Paroli
(M)
F Perrone
(F)
L Petruzzelli
(L)
A Pezzolla
(A)
D Piazza
(D)
V Piazza
(V)
M Piccoli
(M)
A Pisanu
(A)
M Podda
(M)
G Poillucci
(G)
R Porfidia
(R)
G Rossi
(G)
P Ruscelli
(P)
A Spagnoli
(A)
R Sulis
(R)
D Tartaglia
(D)
C Tranà
(C)
A Travaglino
(A)
P Tomaiuolo
(P)
A Valeri
(A)
G Vasquez
(G)
M Zago
(M)
E Zanoni
(E)
Informations de copyright
© 2019. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
U.S. Census Bureau. The elderly population 2010. https://www.census.gov/library/publications/2011/dec/c2010br-09.html . Accessed 3 Feb 2019.
Office for National Statistics (ONS). National population projections 2014-based statistical bulletin 2015. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/bulletins/nationalpopulationprojections/2015-10-292015 . Accessed 3 Feb 2019.
Desserud KF, Veen T, Søreide K. Emergency general surgery in the geriatric patient. Br J Surg. 2016;103:e52–61. https://doi.org/10.1002/bjs.10044 .
doi: 10.1002/bjs.10044
pubmed: 26620724
Etzioni DA, Liu JH, Maggard MA, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg. 2003;238:170–7.
pubmed: 12894008
pmcid: 1422682
Podda M, Cillara N, Di Saverio S. Appendicitis. In: Encyclopedia of gastroenterology. 2nd ed. New York: Elsevier; 2018. https://doi.org/10.1016/b978-0-12-801238-3.66055-5 .
Gomes CA, Sartelli M, Di Saverio S, Ansaloni L, Catena F, Coccolini F, Inaba K, Demetriades D, Gomes FC, Gomes CC. Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg. 2015. https://doi.org/10.1186/s13017-015-0053-2 .
doi: 10.1186/s13017-015-0053-2
pubmed: 26677396
pmcid: 4681030
Storm-Dickerson TL, Horattas MC. What have we learned over the past 20 years about appendicitis in the elderly? Am J Surg. 2003;185:198–201.
doi: 10.1016/S0002-9610(02)01390-9
Sheu BF, Chiu TF, Chen JC, Tung MS, Chang MW, Young YR. Risk factors associated with perforated appendicitis in elderly patients presenting with signs and symptoms of acute appendicitis. ANZ J Surg. 2007;77:662–6.
doi: 10.1111/j.1445-2197.2007.04182.x
Segev L, Keidar A, Schrier I, Rayman S, Wasserberg N, Sadot E. Acute appendicitis in the elderly in the twenty-first century. J Gastrointest Surg. 2015;19:730–5.
doi: 10.1007/s11605-014-2716-9
Renteria O, Shahid Z, Huerta S. Outcomes of appendectomy in elderly veteran patients. Surgery. 2018;164:460–5.
doi: 10.1016/j.surg.2018.04.027
Yeh CC, Wu SC, Liao CC, Su LT, Hsieh CH, Li TC. Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study. Surg Endosc. 2011;25:2932–42.
doi: 10.1007/s00464-011-1645-x
Costa G, Massa G, ERASO (Elderly Risk Assessment for Surgical Outcome) Collaborative Study Group. Frailty and emergency surgery in the elderly: protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study). Updates Surg. 2018;70:97–104.
doi: 10.1007/s13304-018-0511-y
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495–9.
doi: 10.1016/j.ijsu.2014.07.013
NCEPOD Classification of Intervention. https://www.ncepod.org.uk/classification.html . Accessed 3 Feb 2019.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
doi: 10.1097/01.sla.0000133083.54934.ae
Wen SW, Naylor CD. Diagnostic accuracy and short-term surgical outcomes in cases of suspected acute appendicitis. CMAJ. 1995;152:1617–26.
pubmed: 7743448
pmcid: 1337858
Fuchs JR, Schlamberg JS, Shortsleeve MJ, Schuler JG. Impact of abdominal CT imaging on the management of appendicitis: an update. J Surg Res. 2002;106:131–6.
doi: 10.1006/jsre.2002.6441
Pooler BD, Lawrence EM, Pickhardt PJ. MDCT for suspected appendicitis in the elderly: diagnostic performance and patient outcome. Emerg Radiol. 2012;19:27–33.
doi: 10.1007/s10140-011-1002-3
Pickhardt PJ, Levy AD, Rohrmann CA Jr, Kende AI. Primary neoplasms of the appendix manifesting as acute appendicitis: CT findings with pathologic comparison. Radiology. 2002;224:775–81.
doi: 10.1148/radiol.2243011545
Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R, Gurusamy KS, Campanile FC, Biffl W, Chiara O, Moore F, Peitzman AB, Fraga GP, Costa D, Maier RV, Rizoli S, Balogh ZJ, Bendinelli C, Cirocchi R, Tonini V, Piccinini A, Tugnoli G, Jovine E, Persiani R, Biondi A, Scalea T, Stahel P, Ivatury R, Velmahos G, Andersson R. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016. https://doi.org/10.1186/s13017-016-0090-5 .
doi: 10.1186/s13017-016-0090-5
pubmed: 27822294
pmcid: 5097400
Agresta F, Campanile FC, Podda M, Cillara N, Pernazza G, Giaccaglia V, Ciccoritti L, Ioia G, Mandalà S, La Barbera C, Birindelli A, Sartelli M, Di Saverio S, Joined Italian Surgical Societies Working Group. Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years. Surg Endosc. 2017;31:1785–95.
doi: 10.1007/s00464-016-5175-4
Southgate E, Vousden N, Karthikesalingam A, Markar SR, Black S, Zaidi A. Laparoscopic vs open appendectomy in older patients. Arch Surg. 2012;147:557–62.
doi: 10.1001/archsurg.2012.568
Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, Stamos MJ. Does laparoscopic appendectomy impart an advantage over open appendectomy in elderly patients? World J Surg. 2012;36:1534–9.
doi: 10.1007/s00268-012-1545-9
Kim MJ, Fleming FJ, Gunzler DD, Messing S, Salloum RM, Monson JR. Laparoscopic appendectomy is safe and efficacious for the elderly: an analysis using the National Surgical Quality Improvement Project database. Surg Endosc. 2011;25:1802–7.
doi: 10.1007/s00464-010-1467-2
Healthcare cost and utilization project nationwide inpatient sample 2007. https://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp . Accessed 5 Feb 2019.
Moazzez A, Mason RJ, Katkhouda N. Thirty-day outcomes of laparoscopic versus open appendectomy in elderly using ACS/NSQIP database. Surg Endosc. 2013;27:1061–71.
doi: 10.1007/s00464-012-2557-0
Guller U, Jain N, Peterson ED, Muhlbaier LH, Eubanks S, Pietrobon R. Laparoscopic appendectomy in the elderly. Surgery. 2004;135:479–88.
pubmed: 15118584
Jaschinski T, Mosch CG, Eikermann M, Neugebauer EA, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2018;11:CD001546. https://doi.org/10.1002/14651858.cd001546.pub4 .
doi: 10.1002/14651858.cd001546.pub4
pubmed: 30484855
Ukai T, Shikata S, Takeda H, Dawes L, Noguchi Y, Nakayama T, Takemura YC. Evidence of surgical outcomes fluctuates over time: results from a cumulative meta-analysis of laparoscopic versus open appendectomy for acute appendicitis. BMC Gastroenterol. 2016. https://doi.org/10.1186/s12876-016-0453-0 .
doi: 10.1186/s12876-016-0453-0
pubmed: 26979491
pmcid: 4793521
Omari AH, Khammash MR, Qasaimeh GR, Shammari AK, Yaseen MK, Hammori SK. Acute appendicitis in the elderly: risk factors for perforation. World J Emerg Surg. 2014. https://doi.org/10.1186/1749-7922-9-6 .
doi: 10.1186/1749-7922-9-6
pubmed: 24428909
pmcid: 3896723
Lorenzon L, Costa G, Massa G, Frezza B, Stella F, Balducci G. The impact of frailty syndrome and risk scores on emergency cholecystectomy patients. Surg Today. 2017;47:74–83.
doi: 10.1007/s00595-016-1361-1
Hewitt J, Carter B, McCarthy K, Pearce L, Law J, Wilson FV, Tay HS, McCormack C, Stechman MJ, Moug SJ, Myint PK. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing. 2019. https://doi.org/10.1093/ageing/afy217 .
doi: 10.1093/ageing/afy217
pubmed: 30778528
Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Hashmi A, Green DJ, O’Keeffe T, Tang A, Vercruysse G, Fain MJ, Friese RS, Rhee P. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg. 2014;149:766–72.
doi: 10.1001/jamasurg.2014.296
Andersson RE. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg. 2007;31:86–92.
doi: 10.1007/s00268-006-0056-y
van Dijk ST, van Dijk AH, Dijkgraaf MG, Boermeester MA. Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis. Br J Surg. 2018;105:933–45.
doi: 10.1002/bjs.10873
Salminen P, Tuominen R, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, Hurme S, Mecklin JP, Sand J, Virtanen J, Jartti A, Grönroos JM. Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. JAMA. 2018;320:1259–65.
doi: 10.1001/jama.2018.13201
Poillucci G, Mortola L, Podda M, Di Saverio S, Casula L, Gerardi C, Cillara N, Presenti L, ACTUAA-R Collaborative Working Group on Acute Appendicitis. Laparoscopic appendectomy vs antibiotic therapy for acute appendicitis: a propensity score-matched analysis from a multicenter cohort study. Updates Surg. 2017;69:531–40.
doi: 10.1007/s13304-017-0499-8
Podda M, Cillara N, Di Saverio S, Lai A, Feroci F, Luridiana G, Agresta F, Vettoretto N, ACOI (Italian Society of Hospital Surgeons) Study Group on Acute Appendicitis. Antibiotics-first strategy for uncomplicated acute appendicitis in adults is associated with increased rates of peritonitis at surgery. A systematic review with meta-analysis of randomized controlled trials comparing appendectomy and non-operative management with antibiotics. Surgeon. 2017;15:303–14.
doi: 10.1016/j.surge.2017.02.001
Sallinen V, Akl EA, You JJ, Agarwal A, Shoucair S, Vandvik PO, Agoritsas T, Heels-Ansdell D, Guyatt GH, Tikkinen KA. Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis. Br J Surg. 2016;103:656–67.
doi: 10.1002/bjs.10147
Podda M, Gerardi C, Cillara N, Fearnhead N, Gomes CA, Birindelli A, Mulliri A, Davies RJ, Di Saverio S. Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children: a systematic review and meta-analysis. Ann Surg. 2019. https://doi.org/10.1097/sla.0000000000003225 .
doi: 10.1097/sla.0000000000003225
pubmed: 31425282