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You are here: Home / Abstracts / Once a patient is older than 45 years of age, morbidity and mortality is higher in Sleeve gastrectomy and Roux-en-Y gastric bypass: An analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) Data Registry

Once a patient is older than 45 years of age, morbidity and mortality is higher in Sleeve gastrectomy and Roux-en-Y gastric bypass: An analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) Data Registry

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.

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