Sean R Maloney, Nicholas Dugan, Tanushree Prasad, Paul D Colavita, Iain Mckillop, Keith S Gersin, Timothy Kuwada, Selwan Barbat, Amanda Roberts, Abdelrahman Nimeri. Carolinas Medical Center
Background: Bariatric surgery is the most effective modality to treat obesity and obesity-related comorbidities. Several factors including age, sex, and BMI may impact the choice of bariatric procedure. The aim of the study was to utilize the MBASQIP® Data Registry to analyze the limitations age may impose on outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).
Methods: A review of the MBSAQIP® Data Registry Participant User Files for (2015-2016) for patients having SG and RYGB was performed. Patients were divided into 4 age groups (18-44yrs; 45-54yrs; 55-64yrs; >65yrs). Minimal exclusions for revisional and/or emergency surgery were selected. Combination variables were created to group complications as either major (PE, CVA, and MI) or minor (surgical site occurrences). A comorbidity index was constructed to include diabetes, GERD, and previous cardiac surgery. Univariate and multivariate logistic regression analyses were performed comparing each group to the younger age group [18-45yrs].
Results: From a total of 301,605 cases (70.5% SG), 279,419 cases (71.2% SG) remained after applying exclusion criteria (79.2% female, BMI 45.5±8.1kg/m2, 8.9% insulin-dependent diabetic). Mean age was 44.7±12.0yrs with distribution of 51.3% [18-45yrs]; 26.9% [45-54yrs]; 16.3% [55-64yrs]; 5.5% [>65yrs]. Univariate analysis demonstrated preoperative differences of lower BMI with increasing age (46.5±8.3[18-45yrs], 44.8±7.9[45-54yrs], 44.3±7.6[55-64yrs], 43.4±6.9[>65yrs]; p<0.0001 vs [18-45yrs]), concomitant with increasing frequency of RYGB (27.5%[18-45yrs], 29.6%[45-54yrs], 31.0%[55-64yrs], 30.4%[>65yrs]; p<0.0001) and higher comorbidity index (1.2±1.1[18-45yrs], 1.6±1.2[45-54yrs], 2.0±1.2[55-64yrs], 2.2±1.2[>65yrs]; p<0.0001 vs [18-45yrs]). At age >45yrs, major complications (0.60% [18-45yrs] vs 1.02% vs 1.51% vs 2.27%) and 30-day mortality (0.05% [18-45yrs] vs 0.10%[45-54yrs] vs 0.18%[55-64yrs] vs 0.31%[>65yrs]) increased significantly (p<0.0001), independent of SG vs RYGB. Increasing age also increased the likelihood of non-home discharge for RYGB patients, but not SG. A multivariate analysis controlling for comorbidity index, BMI, smoking, sex, and race, demonstrated increased age (>45yrs) at time of surgery led to increased risk for major complications (45-54yr OR 1.45 CI 1.31-1.61; 55-64yr OR 1.96 CI 1.76-2.18, 65+yr OR 2.80 CI 2.45-3.21) and mortality (45-54yr OR 1.93 CI 1.38-2.70, 55-64yr OR 3.18 CI 2.26, 65+yr OR 5.35 CI 3.58-7.98) compared to the youngest age group.
Conclusion: Bariatric surgery remains a low mortality risk procedure for all age groups in SG and RYGB. However, each age group >45yrs had increasing risk of major complications, non-home discharge, and mortality, indicating that delaying surgery is detrimental, even when controlling for increased comorbidities in the aging cohort.
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Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95003
Program Number: S069
Presentation Session: Residents and Fellows Session
Presentation Type: ResFel