Bariatric surgery in the elderly: outcomes analysis of patients over 70 using the ACS-NSQIP database

David M. Pechman, Fernando Muñoz Flores, Corin M. Kinkhabwala, Ruben Salas, Robin H. Berk, David Weithorn, Diego R. Camacho

Research output: Contribution to journalArticle

Abstract

Background: Bariatric surgery offers patients with morbid obesity and related diseases short- and long-term benefits to their health and quality of life. Evidence-based medicine is integral in the evaluation of risk versus benefit; however, data are lacking for several high-risk patient populations, including the elderly. Objectives: This study assessed morbidity and mortality data for patients age ≥70 undergoing laparoscopic sleeve gastrectomy (SG) or laparoscopic Roux-en-Y gastric bypass (RYGB). Setting: University Hospital, Bronx, New York, United States using national database. Methods: We used the American College of Surgeons-National Surgical Quality Improvement Project database for years 2005–2016 and identified patients who underwent primary SG or RYGB. Patients age ≥70 were assigned to the over age 70 (AGE70+) cohort and younger patients were assigned to the under age 70 (U70) cohort. Postoperative length of stay and 30-day morbidity and mortality were assessed. Results: A total of 1498 patients age ≥70 underwent nonrevisional bariatric surgery, including 751 (50.1%) SG and 747 (49.9%) RYGB. AGE70+ was associated with increased mortality and increased rates of cardiac, pulmonary, renal, and cerebrovascular morbidity. AGE70+ patients had longer mean length of stay, and were more likely to require transfusion and return to operative room. When stratified by procedure, rates of organ-space surgical site infection, acute renal failure, urinary tract infection, myocardial infarction, deep vein thrombosis/thrombophlebitis, and septic shock were significantly increased in AGE70+ patients undergoing RYGB but not SG. Impaired functional status was associated with increased rates of morbidity and mortality for AGE70+ patients and for U70 patients, although the small number of patients within each category limited statistical analysis. Conclusions: Evaluation of risk versus benefit is performed on a case-by-case basis, but evidence-based medicine is critical in empowering surgeons and patients to make informed decisions. The overall rate of morbidity and mortality for AGE70+ patients undergoing bariatric surgery was increased relative to U70 patients. Rates of several adverse events, including acute renal failure and myocardial infarction, were increased in AGE70+ patients undergoing RYGB but not SG, suggesting that SG may be the preferred procedure for elderly patients with organ-specific risk factors. The increased rates of morbidity and mortality observed for patients with impaired functional status supports consideration of functional status when evaluating preoperative risk.

Original languageEnglish (US)
JournalSurgery for Obesity and Related Diseases
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

Fingerprint

Bariatric Surgery
Databases
Gastrectomy
Gastric Bypass
Morbidity
Mortality
Evidence-Based Medicine
Acute Kidney Injury
Length of Stay
Myocardial Infarction
Surgical Wound Infection
Thrombophlebitis
Morbid Obesity

Keywords

  • Bariatric surgery
  • Diabetes
  • Elderly
  • Frailty
  • Functional status
  • Gastric bypass
  • Geriatric
  • Laparoscopic
  • Roux-en-Y gastric bypass
  • Sleeve gastrectomy
  • Weight loss surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Bariatric surgery in the elderly : outcomes analysis of patients over 70 using the ACS-NSQIP database. / Pechman, David M.; Muñoz Flores, Fernando; Kinkhabwala, Corin M.; Salas, Ruben; Berk, Robin H.; Weithorn, David; Camacho, Diego R.

In: Surgery for Obesity and Related Diseases, 01.01.2019.

Research output: Contribution to journalArticle

Pechman, David M. ; Muñoz Flores, Fernando ; Kinkhabwala, Corin M. ; Salas, Ruben ; Berk, Robin H. ; Weithorn, David ; Camacho, Diego R. / Bariatric surgery in the elderly : outcomes analysis of patients over 70 using the ACS-NSQIP database. In: Surgery for Obesity and Related Diseases. 2019.
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abstract = "Background: Bariatric surgery offers patients with morbid obesity and related diseases short- and long-term benefits to their health and quality of life. Evidence-based medicine is integral in the evaluation of risk versus benefit; however, data are lacking for several high-risk patient populations, including the elderly. Objectives: This study assessed morbidity and mortality data for patients age ≥70 undergoing laparoscopic sleeve gastrectomy (SG) or laparoscopic Roux-en-Y gastric bypass (RYGB). Setting: University Hospital, Bronx, New York, United States using national database. Methods: We used the American College of Surgeons-National Surgical Quality Improvement Project database for years 2005–2016 and identified patients who underwent primary SG or RYGB. Patients age ≥70 were assigned to the over age 70 (AGE70+) cohort and younger patients were assigned to the under age 70 (U70) cohort. Postoperative length of stay and 30-day morbidity and mortality were assessed. Results: A total of 1498 patients age ≥70 underwent nonrevisional bariatric surgery, including 751 (50.1{\%}) SG and 747 (49.9{\%}) RYGB. AGE70+ was associated with increased mortality and increased rates of cardiac, pulmonary, renal, and cerebrovascular morbidity. AGE70+ patients had longer mean length of stay, and were more likely to require transfusion and return to operative room. When stratified by procedure, rates of organ-space surgical site infection, acute renal failure, urinary tract infection, myocardial infarction, deep vein thrombosis/thrombophlebitis, and septic shock were significantly increased in AGE70+ patients undergoing RYGB but not SG. Impaired functional status was associated with increased rates of morbidity and mortality for AGE70+ patients and for U70 patients, although the small number of patients within each category limited statistical analysis. Conclusions: Evaluation of risk versus benefit is performed on a case-by-case basis, but evidence-based medicine is critical in empowering surgeons and patients to make informed decisions. The overall rate of morbidity and mortality for AGE70+ patients undergoing bariatric surgery was increased relative to U70 patients. Rates of several adverse events, including acute renal failure and myocardial infarction, were increased in AGE70+ patients undergoing RYGB but not SG, suggesting that SG may be the preferred procedure for elderly patients with organ-specific risk factors. The increased rates of morbidity and mortality observed for patients with impaired functional status supports consideration of functional status when evaluating preoperative risk.",
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T1 - Bariatric surgery in the elderly

T2 - outcomes analysis of patients over 70 using the ACS-NSQIP database

AU - Pechman, David M.

AU - Muñoz Flores, Fernando

AU - Kinkhabwala, Corin M.

AU - Salas, Ruben

AU - Berk, Robin H.

AU - Weithorn, David

AU - Camacho, Diego R.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Bariatric surgery offers patients with morbid obesity and related diseases short- and long-term benefits to their health and quality of life. Evidence-based medicine is integral in the evaluation of risk versus benefit; however, data are lacking for several high-risk patient populations, including the elderly. Objectives: This study assessed morbidity and mortality data for patients age ≥70 undergoing laparoscopic sleeve gastrectomy (SG) or laparoscopic Roux-en-Y gastric bypass (RYGB). Setting: University Hospital, Bronx, New York, United States using national database. Methods: We used the American College of Surgeons-National Surgical Quality Improvement Project database for years 2005–2016 and identified patients who underwent primary SG or RYGB. Patients age ≥70 were assigned to the over age 70 (AGE70+) cohort and younger patients were assigned to the under age 70 (U70) cohort. Postoperative length of stay and 30-day morbidity and mortality were assessed. Results: A total of 1498 patients age ≥70 underwent nonrevisional bariatric surgery, including 751 (50.1%) SG and 747 (49.9%) RYGB. AGE70+ was associated with increased mortality and increased rates of cardiac, pulmonary, renal, and cerebrovascular morbidity. AGE70+ patients had longer mean length of stay, and were more likely to require transfusion and return to operative room. When stratified by procedure, rates of organ-space surgical site infection, acute renal failure, urinary tract infection, myocardial infarction, deep vein thrombosis/thrombophlebitis, and septic shock were significantly increased in AGE70+ patients undergoing RYGB but not SG. Impaired functional status was associated with increased rates of morbidity and mortality for AGE70+ patients and for U70 patients, although the small number of patients within each category limited statistical analysis. Conclusions: Evaluation of risk versus benefit is performed on a case-by-case basis, but evidence-based medicine is critical in empowering surgeons and patients to make informed decisions. The overall rate of morbidity and mortality for AGE70+ patients undergoing bariatric surgery was increased relative to U70 patients. Rates of several adverse events, including acute renal failure and myocardial infarction, were increased in AGE70+ patients undergoing RYGB but not SG, suggesting that SG may be the preferred procedure for elderly patients with organ-specific risk factors. The increased rates of morbidity and mortality observed for patients with impaired functional status supports consideration of functional status when evaluating preoperative risk.

AB - Background: Bariatric surgery offers patients with morbid obesity and related diseases short- and long-term benefits to their health and quality of life. Evidence-based medicine is integral in the evaluation of risk versus benefit; however, data are lacking for several high-risk patient populations, including the elderly. Objectives: This study assessed morbidity and mortality data for patients age ≥70 undergoing laparoscopic sleeve gastrectomy (SG) or laparoscopic Roux-en-Y gastric bypass (RYGB). Setting: University Hospital, Bronx, New York, United States using national database. Methods: We used the American College of Surgeons-National Surgical Quality Improvement Project database for years 2005–2016 and identified patients who underwent primary SG or RYGB. Patients age ≥70 were assigned to the over age 70 (AGE70+) cohort and younger patients were assigned to the under age 70 (U70) cohort. Postoperative length of stay and 30-day morbidity and mortality were assessed. Results: A total of 1498 patients age ≥70 underwent nonrevisional bariatric surgery, including 751 (50.1%) SG and 747 (49.9%) RYGB. AGE70+ was associated with increased mortality and increased rates of cardiac, pulmonary, renal, and cerebrovascular morbidity. AGE70+ patients had longer mean length of stay, and were more likely to require transfusion and return to operative room. When stratified by procedure, rates of organ-space surgical site infection, acute renal failure, urinary tract infection, myocardial infarction, deep vein thrombosis/thrombophlebitis, and septic shock were significantly increased in AGE70+ patients undergoing RYGB but not SG. Impaired functional status was associated with increased rates of morbidity and mortality for AGE70+ patients and for U70 patients, although the small number of patients within each category limited statistical analysis. Conclusions: Evaluation of risk versus benefit is performed on a case-by-case basis, but evidence-based medicine is critical in empowering surgeons and patients to make informed decisions. The overall rate of morbidity and mortality for AGE70+ patients undergoing bariatric surgery was increased relative to U70 patients. Rates of several adverse events, including acute renal failure and myocardial infarction, were increased in AGE70+ patients undergoing RYGB but not SG, suggesting that SG may be the preferred procedure for elderly patients with organ-specific risk factors. The increased rates of morbidity and mortality observed for patients with impaired functional status supports consideration of functional status when evaluating preoperative risk.

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KW - Diabetes

KW - Elderly

KW - Frailty

KW - Functional status

KW - Gastric bypass

KW - Geriatric

KW - Laparoscopic

KW - Roux-en-Y gastric bypass

KW - Sleeve gastrectomy

KW - Weight loss surgery

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