Journal of Surgical Education
Volume 67, Issue 3 , Pages 161-166, May 2010

Laparoscopic Colectomy In Octogenarians and Nonagenarians: A Preferable Option to Open Surgery?

Aspects of this work were presented as a poster at the 94th Annual Clinical Congress of the American College of Surgeons, San Francisco, October 2008.

Department of Surgery and the Muller Center for Senior Health, Abington Memorial Hospital, Abington, Pennsylvania

published online 14 May 2010.

Objectives

To determine if laparoscopic colectomy is safer and more effective than open colectomy in patients older than 80 years of age.

Methods

An operating room database of all colectomies performed on patients ≥80 years, from January 2002 to September 2007, was analyzed retrospectively. Data reviewed included type of operation, type of resection, length of procedure, length of stay (LOS), estimated blood loss, American Society of Anesthesiologists (ASA) grade, diagnosis, complications, mortality rates, and discharge destination, with p-values <0.05 considered significant.

Results

One hundred thirty-nine patients underwent open procedures (Open group) during the study period versus 150 patients who underwent laparoscopic procedures (Lap group). Of the Lap group, 15 patients were converted to open cases. Forty-four patients from the Open group were excluded from the analysis as they were treated emergently, leaving 95 patients in the Open group. The mortality for open procedures was significantly higher at 9/95 (9.4%), compared with 3/150 (2%) following laparoscopic procedures (p = 0.0132). LOS was significantly longer for open procedures (11.16 days) versus laparoscopic procedures (7.11 days), p = 0.0001. Open procedures were associated with an increased risk of postoperative ileus (p < 0.02). The Open group had a higher likelihood of discharge to a nursing facility (43/87) than the Lap group (33/147), p < 0.0001. There were no significant differences in the length of procedure, estimated blood loss and postoperative complications.

Conclusions

Laparoscopic colectomy is a safer option that offers an improved outcome compared with open colectomy in elderly patients. Significant improvements in LOS, mortality rates, and discharge destination were observed.

Key Words: laparoscopic colectomy, octogenarians, nonagenarians, open colectomy, length of stay

Competencies: Medical Knowledge, Practice-based Learning and Improvement

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 Competing interests: All authors have declared no conflicts of interest or financial ties to disclose.

PII: S1931-7204(10)00037-1

doi:10.1016/j.jsurg.2010.02.009

Journal of Surgical Education
Volume 67, Issue 3 , Pages 161-166, May 2010

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