MedWire News: Laparoscopic surgery shortens hospital stay in octogenarian patients undergoing rectal surgery compared with an open approach and does not significantly affect other markers of outcome, indicates research published in Colorectal Disease.
Stephen White (John Flynn Medical Centre, Tugun, Queensland, Australia) and co-workers reviewed medical records for 114 patients aged over 79 years who underwent laparoscopic (n=60) or open (n=54) rectal resection between 2000 and 2009.
The patients in the laparoscopic and open surgery groups were matched for age (82.5 vs 83.2 years), American Society of Anesthesiologists score (2.5 vs 2.5) and gender.
The majority of laparoscopic and open surgery patients underwent rectal resection for malignancy (63.3 and 55.6%, respectively). However, laparoscopic surgery was more commonly used than open surgery for diverticulitis (13.3 vs 7.5%), benign disease such as polyps, or Crohn's disease, (6.7 vs 1.9%), and prolapse (11.7 vs 3.6%).
The researchers found no significant differences between the surgery groups in terms of morbidity. Complications were reported for 33% of laparoscopic patients and 46% of open surgery patients, and wound complications occurred in 10% and 18%, respectively, but these differences were not significant. The rate of anastomotic leak did not differ between the groups.
Among patients with uncomplicated recoveries, laparoscopic surgery was associated with a significantly shorter length of stay than open surgery (10 vs 14 days).
The researchers note, however, that early release from hospital was rarely an option for patients due to lack of support at home, with length of stay extended due to the need for care.
"A particular challenge for surgery in elderly patients is preparing them for discharge," White et al comment.
"Many will require temporary or permanent residential accommodation."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
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