Subir Sutradhar, MD, FRCSC, Simon Laplante, MD, Azusa Maeda, PhD, Allan Okrainec, MD, FRCSC, MHPE, Timothy Jackson, MD, FRCSC, MPH. Division of General Surgery, University Health Network, University of Toronto
Introduction: The safety of bariatric surgery in the elderly has been studied with conflicting results and is a topic of debate, given the increasing prevalence of obesity within this population. Many surgical centers use age 65 as their cutoff for offering bariatric surgery. The objective of this study was to determine if the outcome of bariatric surgery (laparoscopic sleeve gastrectomy [LSG] or laparoscopic roux-en-y gastric bypass [LRYGB]) in patients age 65 or over was comparable to that in younger patients, with respect to the odds of readmission and the rates of an adverse event within 30days of surgery.
Methods and Procedures: A retrospective cohort study was performed using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use Data File. Patients were selected if they underwent a LSG or LRYGB between January 1 and December 31, 2015. The primary outcome was the odds of readmission within 30days of surgery. For each type of surgery (i.e. LSG or LRYGB), a multivariable logistic regression was performed to obtain an adjusted odds ratio (OR) of 30-day readmission for patients age 65 or over. Rates of readmission, complications, reoperation, and death within 30days of surgery were also calculated.
Results: Within the LSG group, there were 92699 (94%) patients under age 65 and 5575 (6%) patients age 65 or over. Both groups had similar rates of 30-day readmission (3-4%), reoperation (1%), and death (0.1-0.3%), but the rate of complications was higher in the older group (5% vs. 2%). The adjusted OR for 30-day readmission for patients age 65 or over was 1.13 (p= 0.08, 95% CI [0.99-1.30]).
Within the LRYGB group, there were 40606 (94%) patients under age 65 and 2743 (6%) patients age 65 or over. Both groups had similar rates of 30-day readmission (6-7%), reoperation (3%), and death (0.1-0.5%), but the rate of complications was higher in the older group (11% vs. 6%). The adjusted OR for a 30-day readmission for patients age 65 or over was 1.08 (p= 0.3, 95% CI [0.93-1.26]).
Conclusions: Based on MBSAQIP registry data, patients age 65 or over did not have higher odds of a 30-day readmission compared to younger patients after LSG or LRYGB. Rates of 30-day readmission, reoperation, and death were similar, but rates of complications (e.g. pneumonias, unplanned intubations) were higher in the older group. Bariatric surgery in the elderly should therefore be performed only after careful and patient-centered selection processes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88476
Program Number: P617
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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