APPENDECTOMY INCIDENTAL TO CHOLECYSTECTOMY AMONG ELDERLY MEDICARE BENEFICIARIES

To assess the risks of adverse outcomes after appendectomy incidental to cholecystectomy among elderly Medicare beneficiaries, 8,936 persons undergoing cholecystectomy with incidental appendectomy and 44,461 pe rsons undergoing cholecystectomy without incidental appendectomy were studied. Controlling for age, race, gender and co-morbidity status, th e risk for wound infection in persons with incidental appendectomy was 83 percent higher than in persons without incidental appendectomy (95 percent confidence interval, 1.53 to 2.18). The risks for having othe r adverse outcomes, including other infections, extensive intrahospita l complications and mortality rate at 30 days, were also higher for th e former group, although these differences Were not statistically sign ificant. In addition, the demographic characteristics and health statu s of persons undergoing cholecystectomy with incidental appendectomy w ith persons undergoing cholecystectomy only were compared. Males, pers ons of younger ages, of white race or with no co-morbid conditiOns, we re significantly more likely to undergo cholecystectomy with incidenta l appendectomy. Variables to control for differences in the demographi c characteristics and health status between persons receiving and not receiving incidental appendectomy were included in the regression mode ls for adverse outcomes. However, these models may not completely cont rol for differences between the two groups. As a result, the actual re lationship between incidental appendectomy and adverse outcomes may be underestimated. The preventive effect of incidental appendectomy on m orbidity and mortality rates from future instances of appendicitis was assessed by determining the remaining lifetime risk for acute appendi citis. For persons 65 to 69 years of age, 115 incidental appendectomie s would be required to prevent one future instance of appendicitis and 4,472 incidental appendectomies would be needed to prevent a single f uture death from acute appendicitis. Because incidental appendectomy i ncreases the risk for wound infection among persons undergoing cholecy stectomy and because the lifetime risk for acute appendicitis is relat ively low for persons of this age group, surgeons should carefully con sider die risks and benefits of incidental appendectomy in the elderly .