Rami R Mustafa, MD, Adel Alhaj Saleh, MD, Seyed Mohammad Kalantar Motamedi, MDMPH, Gwen Bonner, MD, Mujjahid Abbas, MD, Tomasz Rogula, Leena Khaitan. Cleveland Medical Center
Background: Surgical treatment of obesity in the elderly remains controversial. As life expectancy increases, more elderly patients fit into the criteria for bariatric surgery. The aim of our study is to evaluate the safety and efficacy of bariatric surgery in elderly patients and determine whether a cut off age for bariatric surgery in the elderly is warranted.
Methods: This is a Retrospective study using the MBSAQIP 2015. Data were collected for demographics, Readmissions, and comorbidities. Postoperative outcomes evaluated include Myocardial infarctions, cardiac arrest, postoperative pneumonia, sepsis, unplanned intubations, Urinary tract infections and other complications. Findings were compared between groups and results were calculated using ASPSS 24, Chi Sq. and T-test.
Results: The data base includes 168,009 patients, of which 22,339 were > 60 years old. Those patients > 60 were classified into 3 groups: 60-70 (G60; 20,468 pts) 71-80 (G70; 1871 pts) and > 80 (G80;32 pts). Females comprised the majority of each group (75% G60; 66.6% G70; and 71.9% G80). BMI differed between groups: 42 kg/m2+10 in G60; 39.35 kg/m2 + 11.8 in G70; 34.7 kg/m2 + 10 in G80. G80 averaged one comorbidity/patient whereas the other groups had 5 comorbidities/patients. Preoperative incidence of DM, Renal insufficiency, Hypertension, Obstructive sleep apnea and Hyperlipidemia were the least in the G80 group. G80 had the highest incidence of post-operative complications: Acute renal failure (3.1%, p=0.009), Myocardial infarction (3.1% , p=0.000), postoperative pneumonia (6.3%, p=0.001), Sepsis (3.1%, p=0.007), reoperation in the first 30 days (9.4%, p=0,01), Post-Operative UTI (6.3%, p=0.000), unplanned intubation (3.1%, p= 0.005), and cases requiring ventilation postoperatively (3.1 % p=0.000 ). G80 had the least incidence of renal insufficiency preoperatively (1.6% in G60, 2.2% in G70 and 0% in G80 , p=0.05) but developed the highest rate of postoperative acute renal failure (3.1%). Pre-Operative Pulmonary comorbidities were greatest in G60 and G70. Post-operative ventilation was higher in G70 than G60 (0.5% versus 0.2%, p= 0.001).
Conclusions: Although the oldest patients in this study had the fewest preoperative comorbidities, they had the highest incidence of complications. Patients over 80 should be approached with caution when considering bariatric surgery. Patients between 60 and 80 should be monitored closely for pulmonary complications. More aggressive pulmonary toilet may be necessary to avoid complications in this group.
Key Words: Bariatric surgery, Elderly, Co-morbidities, post-Operative Complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88059
Program Number: P666
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster