Benefits of laparoscopy in middle-aged patients.

Abstract

The introduction of laparoscopic techniques in biliary, adrenal and thoracic surgery has shortened the patient's hospital stay and lowered costs. However, in colorectal surgery, only a limited number of patients obtain these benefits, and these controversial results have been achieved in laparoscopic appendectomy (LA). The objective of this study was to compare the results of LA performed in young patients (<50 years) to those obtained with older counterparts. All patients who underwent LA and open appendectomy (OA) between January 1996 and December 2000 were analyzed retrospectively. The data included age, gender, American Society of Anesthesiologists (ASA) score, emergent procedure, length of procedure, operating room and hospitalization costs as well as length of stay. For analysis purposes, the patients were divided into two chronological groups: age <50 and age >50 years. A total of 405 patients were available for analysis. Average age was 35 years and 42% were females. Thirty-nine patients underwent LA. The rate of LA was 14% in women and 6% in men (p<0.05). For young patients, there was no difference between LA and OA in ASA score, length of procedure, operating room costs, and total cost. Length of stay was 2.7 days in both the LA and the OA groups (P>0.05). However, patients >50 years in the LA group had a significantly shorter length of stay (2.5 days) than those in compared to the OA group (6 days) (p<0.05). Furthermore, total hospitalization cost was significantly lower for the LA group (13,448 dollars) than for the OA group (21,730 dollars) (p<0.05). No difference was found for length of operation, ASA score, or operating room costs. We found no benefits in terms of cost containment or reduced length of stay for LA patients aged <or=50 years. However, there was a significant decrease in overall costs for LA patients >50 years old. We attribute this diminution of the benefits of LA in younger patients probably diminished due to their lower rate of comorbid conditions and better tolerance of surgical stress.