Is laparoscopic surgery safe for elderly patients with diverticulitis? A national database study

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Geriatric Medicine

Background:

• Diverticulitis is common in older adults, but safety data for laparoscopic surgery in this demographic is limited.
• Laparoscopy is the preferred approach for elective diverticulitis surgery and is gaining traction in emergent settings.

Purpose of the Study:

• To compare 30-day outcomes of laparoscopic versus open surgery for diverticulitis in patients aged 65 and older.
• To evaluate safety and efficacy in both elective and urgent/emergent surgical scenarios.

Main Methods:

• Analysis of patients aged 65+ who underwent diverticulitis surgery between 2015-2019 using the ACS-NSQIP database.
• Separated analysis for elective and non-elective (urgent/emergent) cases.
• Coarsened exact matching to create comparable laparoscopic and open surgical cohorts based on preoperative factors.

Main Results:

• Laparoscopy was associated with significantly lower 30-day morbidity in both elective (OR 0.47) and non-elective (OR 0.76) groups.
• Fewer surgical site infections (SSIs) were observed with laparoscopy in both elective (OR 0.43) and non-elective (OR 0.66) cohorts.
• Laparoscopic surgery resulted in a shorter length of stay (LOS) by 1.7 days (elective) and 1.2 days (non-elective).

Conclusions:

• Laparoscopic surgery for diverticulitis in elderly patients is associated with reduced 30-day morbidity, fewer SSIs, and shorter LOS compared to open surgery.
• The findings support the safety and efficacy of laparoscopy for both elective and select emergent diverticulitis cases in older adults.