Skip to main content

Advertisement

SpringerLink
Log in

A 5-year characterization of trends and outcomes in elderly patients undergoing elective bariatric surgery

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The North American population with severe obesity is aging and with that so will the number of elderly patients (≥ 65 years) meeting indications for metabolic surgery. Trends in bariatric delivery in this population are poorly characterized and outcomes remain conflicting, limiting potential uptake and delivery.

Methods

The MBSAQIP database was used to identify elderly patients (≥ 65 years) undergoing elective bariatric surgery from 2015 to 2019. Our objectives were to analyze their unique characteristics, surgical operative trends, and outcomes by comparing to a non-elderly cohort. Multivariable logistic regression identified independent predictors of serious complications and 30-day mortality.

Results

There was a total of 751,607 patients, 5.3% (n = 39,854) were elderly. Mean ages were 43 ± 11 years (non-elderly) versus 68 ± 3 years (elderly). Elderly patients were less likely to be female (70.7% elderly; 80.1% non-elderly) and had lower BMI (43.17 ± 6.64 kg/m2 elderly; 45.42 ± 7.87 kg/m2 non-elderly). They had higher American Society of Anesthesiologists classification, lower functional status, more insulin dependent diabetes, and hypertension, among other comorbidities. There were no clinically significant differences between the most frequently performed bariatric surgery. Sleeve gastrectomy remained the most common (73.7% non-elderly; 72.3% elderly); however, operative time was longer among the elderly. Functional status was most predictive for both serious complications (OR 1.72; CI 1.53–1.94) and mortality (OR 2.92; CI 1.98–4.31). Surgery among elderly patients was associated with poorer 30-day postoperative outcomes across all categories and was independently associated with serious complications (OR 1.23; CI 1.17–1.30, p < 0.001; AR 4.64%) and 30-day mortality (OR 2.49; CI 2.00–3.11, p < 0.001; AR 0.27%), after adjusting for comorbidities.

Conclusions

After adjusting for comorbidities, functional status remains the most predictive factor for poor outcomes; however, elderly patients have increased 30-day odds of serious complications and 30-day mortality, suggesting a need to tailor our approach to these individuals that carry a unique operative risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hales CM, Carroll MD, Fryar CD, Ogden C (2020) Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief 2020:1–8

    Google Scholar 

  2. Boutari C, Mantzoros CS (2022) A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism 133:155217

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Wiacek M, Zubrzycki IZ, Tomasiuk R (2021) Worldwide obesity trends: an analysis of WHO Data3. J Obes Body Weight 2:005

    Google Scholar 

  4. Statistics Canada (2022) In the midst of high job vacancies and historically low unemployment, Canada faces record retirements from an aging labour force: number of seniors aged 65 and older grows six times faster than children 0-14. https://www150.statcan.gc.ca/n1/daily-quotidien/220427/dq220427a-eng.htm

  5. Statistics Canada (2022) A portrait of Canada’s growing population aged 85 and older from the 2021 Census. https://www12.statcan.gc.ca/census-recensement/2021/as-sa/98-200-X/2021004/98-200-X2021004-eng.cfm

  6. Hamidi M, Joseph B (2019) Changing epidemiology of the American population. Clin Geriatr Med 35:1–12

    Article  PubMed  Google Scholar 

  7. Buch A, Marcus Y, Shefer G, Zimmet P, Stern N (2021) Approach to obesity in the older population. J Clin Endocrinol Metab 106:2788–2805

    Article  PubMed  Google Scholar 

  8. Gebhart A, Young MT, Nguyen NT (2015) Bariatric surgery in the elderly: 2009–2013. Surg Obes Relat Dis 11:393–398

    Article  PubMed  Google Scholar 

  9. Pechman DM, Muñoz Flores F, Kinkhabwala CM et al (2019) Bariatric surgery in the elderly: outcomes analysis of patients over 70 using the ACS-NSQIP database. Surg Obes Relat Dis 15:1923–1932

    Article  PubMed  Google Scholar 

  10. Koh CY, Inaba CS, Sujatha-Bhaskar S, Nguyen NT (2018) Outcomes of laparoscopic bariatric surgery in the elderly population. Am Surg 84:1600–1603

    Article  PubMed  Google Scholar 

  11. Giordano S, Victorzon M (2015) Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging 10:1627–1635

    PubMed  PubMed Central  Google Scholar 

  12. Edwards MA, Mazzei M, Agarwal S, Rhodes L, Bruff A (2021) Exploring perioperative outcomes in metabolic and bariatric surgery amongst the elderly: an analysis of the 2015–2017 MBSAQIP database. Surg Obes Relat Dis 17:1096–1106

    Article  PubMed  Google Scholar 

  13. Vinan-Vega M, Diaz Vico T, Elli EF (2019) Bariatric surgery in the elderly patient: safety and short-time outcome. A case match analysis. Obes Surg 29:1007–1011

    Article  PubMed  Google Scholar 

  14. Pajecki D, Dantas ACB, Kanaji AL, de Oliveira DRCF, de Cleva R, Santo MA (2020) Bariatric surgery in the elderly: a randomized prospective study comparing safety of sleeve gastrectomy and Roux-en-Y gastric bypass (BASE Trial). Surg Obes Relat Dis 16:1436–1440

    Article  PubMed  Google Scholar 

  15. Giordano S, Victorzon M (2018) Laparoscopic roux-en-y gastric bypass in elderly patients (60 years or older): a meta-analysis of comparative studies. Scand J Surg 107:6–13

    Article  CAS  PubMed  Google Scholar 

  16. Dang JT, Mocanu V, Verhoeff K, Allemang M, Kroh M, Karmali S (2022) Predicting serious complications following bariatric surgery in geriatric patients: development of the GeriBari scoring tool using the MBSAQIP database. Surg Obes Relat Dis 19:195

    Article  PubMed  Google Scholar 

  17. Ho HY, Hsu C-H, Ho KL et al (2021) Safety of robotic bariatric surgery in older adults: a 5-year analysis of the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP) database. J Am Coll Surg 233:e3

    Article  Google Scholar 

  18. Khan MA, Grinberg R, Johnson S, Afthinos JN, Gibbs KE (2013) Perioperative risk factors for 30-day mortality after bariatric surgery: is functional status important? Surg Endosc 27:1772–1777

    Article  PubMed  Google Scholar 

  19. Zietlow KE, Wong S, Heflin MT et al (2022) Geriatric preoperative optimization: a review. Am J Med 135:39–48

    Article  PubMed  Google Scholar 

  20. Lak KL, Helm MC, Higgins RM, Kindel TL, Gould JC (2019) Preoperative functional health status is a predictor of short-term postoperative morbidity and mortality after bariatric surgery. Surg Obes Relat Dis 15:608–614

    Article  PubMed  Google Scholar 

  21. Gondal AB, Hsu C-H, Zeeshan M, Hamidi M, Joseph B, Ghaderi I (2019) A frailty index and the impact of frailty on postoperative outcomes in older patients after bariatric surgery. Surg Obes Relat Dis 15:1582–1588

    Article  PubMed  Google Scholar 

  22. Eisenberg D, Shikora SA, Aarts E et al (2022) 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis 18:1345–1356

    Article  PubMed  Google Scholar 

  23. Panayi AC, Orkaby AR, Sakthivel D et al (2019) Impact of frailty on outcomes in surgical patients: a systematic review and meta-analysis. Am J Surg 218:393–400

    Article  CAS  PubMed  Google Scholar 

  24. McIsaac DI, Jen T, Mookerji N, Patel A, Lalu MM (2017) Interventions to improve the outcomes of frail people having surgery: a systematic review. PLoS ONE 12:e0190071

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors, Samantha Albacete, Kevin Verhoeff, Valentin Mocanu, Daniel W. Birch, Shahzeer Karmali, and Noah J. Switzer, have no sources of funding to declare.

Author information

Authors and Affiliations

  1. Department of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Dvorkin Lounge Mailroom 2G2, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada

    Samantha Albacete

  2. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Kevin Verhoeff, Valentin Mocanu & Noah J. Switzer

  3. Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada

    Daniel W. Birch & Shahzeer Karmali

Authors
  1. Samantha Albacete
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin Verhoeff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valentin Mocanu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel W. Birch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shahzeer Karmali
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Noah J. Switzer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samantha Albacete.

Ethics declarations

Disclosures

The authors, Samantha Albacete, Kevin Verhoeff, Valentin Mocanu, Daniel W. Birch, Shahzeer Karmali, and Noah J. Switzer, have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Albacete, S., Verhoeff, K., Mocanu, V. et al. A 5-year characterization of trends and outcomes in elderly patients undergoing elective bariatric surgery. Surg Endosc 37, 5397–5404 (2023). https://doi.org/10.1007/s00464-023-10029-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-023-10029-6

Keywords

Search

Navigation