Elizabeth Hechenbleikner, MD, Kamyar Hariri, MD, Matthew Dong, MD, MPH, Daniel Herron, MD, Gustavo Fernandez-Ranvier, MD, PhD. Mount Sinai Hospital, Garlock Division of Surgery
INTRODUCTION: Bariatric surgeons are now performing primary and revisional procedures on the extremes of age. There is controversy surrounding the safety and effectiveness of bariatric surgery among older age groups compared to younger age groups. To address this knowledge gap, we designed a study assessing short-term bariatric surgery outcomes among various age groupings across a large national database.
METHODS and PROCEDURES: De-identified patient data across 2015 from the MBSAQIP registry was used. Age groupings were organized into young, middle-aged, and older adults (in years) as follows: <40, 40-60, and >60, respectively. The following 30-day outcomes were evaluated between all possible pairwise age groupings: mortality, surgical site infection (SSI), and readmission; logistic regression was used to compare outcomes between age groupings controlling for primary vs. revisional index operation, patient factors, and procedure factors. A p value of < 0.05 was deemed statistically significant.
RESULTS: A total of 168,058 patients were identified (age range: 13 to >80); 86% (n= 144,507) underwent primary bariatric operations while 14% (n= 23,551) underwent revisional cases. Older adults had significantly worse outcomes than middle-aged and younger adults, respectively, for over 100 comparisons across all 3 outcomes; in contrast, younger adults had significantly worse outcomes than middle-aged adults for only 14 comparisons across SSI and readmission. For primary bariatric cases, older adults had significantly higher mortality rates than middle-aged and younger adults, respectively, in the following categories: ASA 3, laparoscopic sleeve gastrectomy (LSG), or laparoscopic Roux-en-Y gastric bypass (LRYGB). For revisional cases, older adults had significantly higher mortality rates than middle-aged and younger adults, respectively, in the setting of female gender, Caucasian race, or ASA 3. Regarding SSI, older adults undergoing primary LRYGB had significantly higher organ space infections compared to younger adults. In addition, older adults who had revisional LRYGB had significantly higher deep surgical site infections compared to middle-aged adults. Following primary bariatric cases, older adults had significantly higher readmission rates compared to younger adults in the presence of male gender, Caucasian race, ASA 3, COPD, or after LSG. Following revisional cases, older adults had significantly higher readmission rates than middle-aged and younger adults, respectively, in the setting of pre-operative chronic steroid use.
CONCLUSIONS: Overall, older adults had worse short-term outcomes compared to their younger counterparts following primary and revisional cases. Further research is required to investigate these findings with the goal of targeting interventions to improve outcomes among bariatric surgical patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88128
Program Number: P664
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster