Factors associated with postoperative complications following appendectomy in elderly patients

Lapsekili, Emin; Deniz, Abdulkadir; Celik, Suleyman Utku

doi:10.1590/1806-9282.20210672

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Brasil

Revista da Associação Médica Brasileira

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Brasil

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Sumário

Original Article • Rev. Assoc. Med. Bras. 67 (10) • Oct 2021 • https://doi.org/10.1590/1806-9282.20210672 copy

Factors associated with postoperative complications following appendectomy in elderly patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Appendicitis in elderly patients is more challenging due to delayed presentation and higher comorbidities, which are associated with increased postoperative morbidity. The aim of this study was to evaluate factors that predict 30-day complications in elderly patients undergoing appendectomy.

METHODS:

The records of elderly patients who underwent appendectomy were reviewed. The primary outcome was 30-day postoperative complications. Independent variables examined included demographic data, comorbidities, preoperative laboratory values, pathological findings, and surgical features. Both univariate and multivariate regression analyses were performed to identify factors associated with postoperative complications.

RESULTS:

Evaluation was performed on 80 patients, comprising 63.8% females with a mean age of 71.3 years. Notably, 19 (23.8%) patients had one or more complications within 30 days after surgery. No significant difference was found between patients with and without complications in respect of age, gender, or laboratory features. The rates of American Society of Anesthesiologists scores 3–4 (p=0.006), hypertension (p=0.016), cardiovascular disease (p=0.049), and obesity (p=0.040) were significantly higher for patients with complications than for those without. On multivariate analysis, obesity (OR 9.41), chronic obstructive pulmonary disease (OR 9.72), and open appendectomy (OR 14.87) were independently associated with 30-day postoperative complications.

CONCLUSIONS:

Older patients undergoing appendectomy tend to have poorer outcomes than younger patients. Therefore, it is critical to identify factors that could reduce the possibility of adverse outcomes in this frail population. The results of this study suggest that obesity, chronic obstructive pulmonary disease, and an open approach are independent factors for complications in elderly patients undergoing appendectomy.

KEYWORDS:
Appendicitis; Appendectomy; Elderly; Postoperative complications

Demographic characteristics
Age (years)		71.3±5.9 (range, 65–87)
Female gender, n (%)		51 (63.8)
Body mass index (kg/m²2 Cohen-Arazi O, Dabour K, Bala M, Haran A, Almogy G. Management, treatment and outcomes of acute appendicitis in an elderly population: a single-center experience. Eur J Trauma Emerg Surg. 2017;43(5):723-7. https://doi.org/10.1007/s00068-016-0735-9 https://doi.org/10.1007/s00068-016-0735-... )		28.1±5.9 (range, 15.7–47.8)
Comorbidities
ASA classification, n (%)
	1–2	59 (73.8)
	3–4	21 (26.3)
Hypertension, n (%)		44 (55.0)
Diabetes mellitus, n (%)		23 (28.8)
Cardiovascular disease, n (%)		20 (25.0)
COPD, n (%)		8 (10.0)
Kidney disease, n (%)		5 (6.3)
Preoperative evaluation
	Leukocyte (×10⁹9 Renteria O, Shahid Z, Huerta S. Outcomes of appendectomy in elderly veteran patients. Surgery. 2018;164(3):460-5. https://doi.org/10.1016/j.surg.2018.04.027 https://doi.org/10.1016/j.surg.2018.04.0... /L)	14.2±5.0 (range, 6.0–28.1)
	Neutrophil (×10⁹9 Renteria O, Shahid Z, Huerta S. Outcomes of appendectomy in elderly veteran patients. Surgery. 2018;164(3):460-5. https://doi.org/10.1016/j.surg.2018.04.027 https://doi.org/10.1016/j.surg.2018.04.0... /L)	11.4±4.9 (range, 1.5–24.5)
	Lymphocyte (×10⁹9 Renteria O, Shahid Z, Huerta S. Outcomes of appendectomy in elderly veteran patients. Surgery. 2018;164(3):460-5. https://doi.org/10.1016/j.surg.2018.04.027 https://doi.org/10.1016/j.surg.2018.04.0... /L)	1.6±0.7 (range, 0.5–3.7)
	C-reactive protein (mg/L)	147.7±109.3 (range, 1.5–457)
Diagnostic study, n (%)
	Only USG	27 (33.8)
	USG and CT	53 (66.3)
Surgical and pathological features
Surgical technique, n (%)
	Open	58 (72.5)
	Laparoscopic	22 (27.5)
Pathological findings, n (%)
	Uncomplicated appendicitis	49 (61.3)
	Complicated appendicitis	31 (38.8)
Postoperative outcomes
	ICU stay, n (%)	23 (28.8)
	Length of ICU stay (days)	0.7±1.9 (0–14)
	Length of hospital stay (days)	6.0±4.7 (range, 1–24)
	In-hospital mortality, n (%)	1 (1.3)
	30-Day complication, n (%)	19 (23.8)
	30-Day readmission, n (%)	10 (12.5)
	30-Day rehospitalization, n (%)	2 (2.5)

		Patients without complications (n=61)	Patients with complications (n=19)	p-value
Age (years)^* * Values are represented as median (range). †Data are expressed as mean±standard deviation. Statistically significant results (p<0.05) were written in bold format		69 (65–87)	74 (65–84)	0.088
Male gender, n (%)		19 (31.1)	10 (52.6)	0.089
Body mass index (kg/m²2 Cohen-Arazi O, Dabour K, Bala M, Haran A, Almogy G. Management, treatment and outcomes of acute appendicitis in an elderly population: a single-center experience. Eur J Trauma Emerg Surg. 2017;43(5):723-7. https://doi.org/10.1007/s00068-016-0735-9 https://doi.org/10.1007/s00068-016-0735-... ), n (%)				0.040
	<30	47 (77.0)	10 (52.6)
	≥30	14 (23.0)	9 (47.4)
ASA classification, n (%)				0.006
	1–2	50 (82.0)	9 (47.4)
	3–4	11 (18.0)	10 (52.6)
Hypertension, n (%)		29 (47.5)	15 (78.9)	0.016
Diabetes mellitus, n (%)		17 (27.9)	6 (31.6)	0.755
Cardiovascular disease, n (%)		12 (19.7)	8 (42.1)	0.049
COPD, n (%)		4 (6.6)	4 (21.1)	0.086
Kidney disease, n (%)		4 (6.6)	1 (5.3)	1.000
Leukocyte (×10⁹9 Renteria O, Shahid Z, Huerta S. Outcomes of appendectomy in elderly veteran patients. Surgery. 2018;164(3):460-5. https://doi.org/10.1016/j.surg.2018.04.027 https://doi.org/10.1016/j.surg.2018.04.0... /L)^†		14.1±5.0	14.3±5.0	0.879
C-reactive protein (mg/L)^*		120 (1.5–409)	142 (34–457)	0.263
Surgical technique, n (%)				0.058
	Open	41 (65.6)	17 (89.5)
	Laparoscopic	20 (32.8)	2 (10.5)
Complicated appendicitis, n (%)		25 (41.0)	6 (31.6)	0.462
ICU stay, n (%)		14 (23.0)	9 (47.4)	0.040
Length of ICU stay (days)^* * Values are represented as median (range). †Data are expressed as mean±standard deviation. Statistically significant results (p<0.05) were written in bold format		0 (0–6)	0 (0–14)	0.018
Length of hospital stay (days)^* * Values are represented as median (range). †Data are expressed as mean±standard deviation. Statistically significant results (p<0.05) were written in bold format		4 (1–14)	5 (1–24)	<0.001
In-hospital mortality, n (%)		0	1 (5.3)	0.237
30-Day readmission, n (%)		3 (4.9)	7 (36.8)	0.001
30-Day rehospitalization, n (%)		1 (1.6)	1 (5.3)	0.421

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[1] *Corresponding author: s.utkucelik@hotmail.com