Melanie T Howell, MD1, Raul Sebastian, MD2, Ambar Mehta1, Gina Adrales1, Alisa Coker1, Thomas Magnuson1, Michael Schweitzer1, Hien T Nguyen1. 1Johns Hopkins, 2George Washington
Introduction: Bariatric surgery has been demonstrated to be a reliable, safe treatment for obesity and its comorbid conditions. With the aging US population and a longer disability-free life expectancy, the safety of laparoscopic bariatric surgery in an older population warrants further investigation. As the demographics of our population shift the question remains: should elective bariatric operations be routinely offered?
Methods: Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, 30-day complications and outcomes were evaluated in patients undergoing RYGB or sleeve gastrectomy. These patients were stratified by age into a mature adult (MA) category (45-64 years of age) and an advanced-age (AA) category (65-80 years of age). Cohorts were matched by co-morbid conditions using propensity score match in SPSS. Patients with similar characteristics based on ASA status, BMI, DM, functional status, and other parameters were selected. The groups were comprised of 2700 individuals for RYGB and 5498 undergoing sleeve gastrectomy.
Results: Outcomes in our matched cohorts undergoing bariatric surgery showed that MA and AA patients did not differ significantly when looking at the presence of pre-existing comorbid conditions. However, when patients underwent RYGB the advanced-age group had a higher rate of cardiac complications (MA 0.11% and AA 0.44%, p=0.035), pulmonary complications (MA 0.30% and AA 1.04%, p=0.001), unplanned ICU admissions (MA 2.04% and AA 3.04%, p=0.022), longer lengths of hospitalization (MA 2.32 +/- 2.64 and AA 2.55+/-3.51, p=0.001) and increased 30-day mortality (MA 0.11% and AA 0.56%, p=0.008). Similarly, when patients underwent sleeve gastrectomy the advanced-age group had a higher rate of renal complications (MA 0.11% and AA 0.44%, p=0.016), unplanned ICU admissions (MA 0.87% and AA 1.35% p=0.018), operative times (MA 80.50 +/- 40.5 and AA 82.34 +/- 38.9, p=0.015), and longer length of stay (MA 1.81 +/- 2.04 and AA 1.91+/-1.92, p=0.007). The 30-day mortality rates for sleeve gastrectomy were also increased (MA 0.11% and AA 0.31%, p=0.022).
Conclusion: Although the mortality after RYGB and sleeve gastrectomy is relatively higher in AA patients compared to MA patients, the absolute risk of mortality is low and favorable compared to other abdominal procedures. Sleeve gastrectomy may be a safer choice in a patient of advance-age, as AA patients undergoing RYGB exhibit higher rates of post-operative cardiac and pulmonary complications which may necessitate ICU care. However, it is reasonable and safe to perform RYGB in the AA population with appropriate postoperative cardiac and pulmonary support.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87802
Program Number: P574
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster