David M Pechman, MD1, Ruben Salas, MD1, Fernando Munoz-Flores, MD1, Corin M Kinkhabwala, BA2, David Weithorn1, MD, Diego R Camacho, MD1. 1Montefiore Medical Center, 2Albert Einstein College of Medicine
Introduction: Bariatric surgery offers patients tremendous benefits to their short and long-term health and their quality of life. Careful patient selection and consideration of risk is especially critical in elective surgical procedures. Risk aversion is important, however “high risk” patients may have the greatest potential to benefit from weight-loss surgery and improvement of comorbid disease. Evidence-based medicine is instrumental in the assessment of risk versus benefit, however data is lacking for several high risk patient populations, including those at the extremes of BMI or age. This study assessed morbidity and mortality data for patients with BMI greater than 70 kg/m2 or age greater than 70 years.
Methods: Patients were selected from operative logs at Montefiore Medical Center from 2014-2017. Patients were included if they underwent primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (GB). Patients with preoperative BMI greater than 70 kg/m2 were assigned to the BMI70+ cohort. Patients age 70 and above were assigned to the AGE70+ cohort. All other patients were assigned to the control cohort. Length of stay and 30-day morbidity and mortality were assessed.
Results: 3451 patients underwent non-revisional bariatric surgery, including 2300 (66.6%) SG and 1151 (33.3%) GB. The BMI70+ cohort included 34 (1.0%) patients, 30 SG and 4 GB. The AGE70+ cohort included 11 (0.3%) patients, too few for comparison. The BMI70+ patients were younger (36.2 vs 41.6 years, p=0.009) and more frequently male (35.3% vs 16%, p=0.002) than control patients, but demographics were otherwise similar. Rates of comorbid conditions were similar as well. Operative time was similar for BMI70+ undergoing SG (61.5 vs 67.5 minutes, p=0.248) and GB (112 vs 107 minutes, p=0.778) relative to control. BMI70+ was associated with increased incidence of pulmonary embolism (2.9% vs 0.1%, p=0.029) and readmission (8.9% vs 3.2%, p=0.061). BMI70+ and control patients had similar lengths of stay (2.1 vs 1.8 days, p=0.097) and comparably low rates of surgical site infection (0 vs 0.9%, p=0.942), acute coronary syndromes (0% vs 0.06%, p=0.98), pneumonia (0 vs 0.03%, p=0.990), renal failure (none), and mortality (0% vs 0.09%, p=0.971).
Conclusion: BMI70+ patients undergoing bariatric surgery had increased rates of pulmonary embolism and readmission, however overall major morbidity and mortality were similar to control patients. Further study is warranted to help guide patient selection and operative planning for patients at the extremes of BMI and age. We next plan to assess preoperative factors and outcomes using national MBSAQIP and NSQIP databases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94714
Program Number: P092
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster