Age is associated with increased morbidity after laparoscopic appendectomy

Background: Laparoscopic appendectomy is one of the most common emergency general surgery procedures in the United States. Little is known about its postoperative outcomes for older adults because appendicitis typically occurs in younger patients. The purpose of this study was to examine the association between age and postoperative complications after appendectomy. We hypothesized that age would have a significant and nonlinear association with morbidity. Methods: We conducted a retrospective cohort study of individuals whose laparoscopic appendectomies were recorded in the Veterans Affairs (VA) Surgical Quality Improvement Program (from 2000–2018; n = 14,619) and National Surgical Quality Improvement Program (2005–2019; n = 349,909) databases. The primary outcome was 30-day morbidity. We used logistic regression with fractional polynomials to model nonlinear relationships between age and outcomes. Results: The median age (interquartile range) of the nonveteran cohort was 36 years (26–51; 8.4% of patients were 65 or older) versus 51 years among veterans (35–63; 21% were 65 or older). For veterans and nonveterans, there was a significant and nonlinear relationship between age and risk of complications. In the nonveteran cohort, the predicted probability (with 95% confidence interval) of postoperative complications was 9.8% (9.7–10.1) at age 65, 11.9% (11.7–12.3) at age 75, and 14.5% (14.1–14.9) at age 85. Among veterans, the risk was 7.5% (6.9–8.1) at age 65, 8.3% (7.6–9.1) at age 75, and 9.1% (8.1–10.1) at age 85. Conclusion: For both veterans and nonveterans, older age was associated with a significantly increased risk of postoperative complications. Notably, morbidity within the VA was lower for older adults than in non-VA hospitals.