Bariatric surgery outcomes in geriatric patients: a contemporary, nationwide analysis

Abstract

OBJECTIVE: This retrospective study sought to characterize the incidence of mortality in elderly patients following bariatric surgery and assessed the association of geriatric status with postoperative outcomes and resource use. BACKGROUND: Bariatric surgery is a safe and efficacious intervention for obesity and related diseases. The clinical and economic impact of geriatric status on bariatric surgery is largely unexplored. SETTING: Academic, university-affiliated hospital; US. METHODS: Adults (≥45 yr) undergoing elective laparoscopic gastric bypass or sleeve gastrectomy were identified in the 2016-2019 Nationwide Readmissions Database. Patients ≥65 years were categorized into the geriatric cohort. Multivariable linear and logistic models were developed to evaluate the independent association of geriatric status with outcomes of interest. RESULTS: Of an estimated number of 351,292 patients meeting inclusion criteria, 44,183 (12.6%) comprised the geriatric cohort. Of these patients, .3% died during the index hospitalization. Geriatric status was associated with significantly increased odds of in-hospital mortality (adjusted odds ratio [AOR] = 2.39, 95% confidence interval [CI]: 1.33-4.30), respiratory (AOR = 1.34, 95% CI: 1.13-1.59), infectious (AOR = 1.65, 95% CI: 1.25-2.17), and renal complications (AOR = 1.27, 95% CI: 1.12-1.46), and prolonged hospitalization (AOR = 1.35, 95% CI: 1.24-1.48). Elderly patients experienced a .19-day increment in the length of stay (95% CI: .11-.27) and $620 in attributable hospitalization costs (95% CI: 310-930). CONCLUSIONS: While overall rates of postoperative death and complications are low, geriatric patients experience significantly increased mortality, morbidity, and resource use following bariatric operations relative to younger adults. These findings may aid in shared decision-making for obesity management in geriatric patients.

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