Impact of age on risk of complications after gastric bypass: A cohort study from the Scandinavian Obesity Surgery Registry (SOReg)

doi:10.1016/j.soard.2017.12.024

Surgery for Obesity and Related Diseases

Volume 14, Issue 4, April 2018, Pages 437-442

https://doi.org/10.1016/j.soard.2017.12.024 Get rights and content

Abstract

Background

An increasing number of older patients undergo bariatric surgery.

Objective

To define the risk for complications and mortality in relation to age after gastric bypass.

Setting

A national registry-based study.

Methods

Patients (n = 47,660) undergoing gastric bypass between May 2007 and October 2016 and registered in the Scandinavian Obesity Register were included. Risk between age groups was compared by multivariate analysis.

Results

The 30-day follow-up rate was 98.1%. In the entire cohort of patients, any complication within 30 days was demonstrated in 8.4%. For patients aged 50 to 54, 55 to 59, and ≥60 years, this risk was significantly increased to 9.8%, 10.0%, and 10.2%, respectively. Rates of specific surgical complications, such as anastomotic leak, bleeding, and deep infections/abscesses were all significantly increased by 14% to 41% in patients aged 50 to 54 years, with a small additional, albeit not significant, increase in risk in patients of older age. The risk of medical complications (thromboembolic events, cardiovascular, and pulmonary complications) was significantly increased in patients aged ≥60 years. Mortality was .03% in all patients without differences between groups.

Conclusions

In this large data set, rates of complications and mortality after 30 days were low. For many complications, an increased risk was encountered in patients aged ≥50 years. However, rates of complications and mortality were still acceptably low in these age groups. Taking the expected benefits in terms of weight loss and improvements of co-morbidities into consideration, our findings suggest that patients of older age should be considered for surgery after thorough individual risk assessment rather than denied bariatric surgery based solely on a predefined chronologic age limit.

Section snippets

The Scandinavian Obesity Registry

In Sweden, a nationwide registry for collection of data for bariatric surgery (Scandinavian Obesity Surgery Registry [SOReg]) was established in May 2005. The aim was to obtain as complete a registration as possible of all procedures performed in Sweden and to provide the participating hospitals with information on results including complications.

SOReg is financially supported by the Swedish National Board of Health and Welfare and approved by the Swedish Surgical Society. It uses an Internet

Patients and operative data

Table 1 shows patients and clinical characteristics for the 47,660 patients included. Seventy-six percent were female, and the median age was higher among males compared with females (42.9 versus 40.3 yr; P<.05). The proportion of patients with diabetes was higher in males compared with females (23.2% versus 11.4%; P<.05) whereas the frequency of smoking was lower (12.5% versus 14.4%; P<.05).

Of the procedures, 97% were performed laparoscopically and 2.3% were open surgery. Conversion from

Discussion

In this study, we report that in a large cohort of patients undergoing primary gastric bypass, rates of complications and mortality within 30 days after surgery were low. In accordance with some previous reports [4], [8], [9], there was an increased risk of complications with increasing age. The new finding is that this increase was apparent for almost all surgical complications in patients aged ≥50 years, whereas for medical complications the main increase was seen only in patients aged>60

Conclusion

In conclusion, the data from this large-scale cohort study demonstrate that complication rates after laparoscopic gastric bypass are low. Significant increases in risk of most surgical complications seem to occur as early as the age of 50 years and older, whereas increases in risk of medical complications were encountered only in patients of older age. However, the observed risks of severe complications and mortality could be considered to be within an acceptable range also for older patients.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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Cited by (21)

Metabolic Bariatric surgery in People with Obesity aged ≥65 Years
2024, European Journal of Internal Medicine
Obesity management guidelines recommend metabolic bariatric surgery for individuals with body mass index (BMI) ≥35 kg/m², regardless of the presence of any obesity-related comorbidity; and for individuals with BMI 30–34.9 kg/m² with metabolic diseases. Older age is not in itself a contraindication for bariatric surgeries, which can be performed after careful selection and assessment, to decrease the risks of postoperative complications. An essential amount of data has accumulated about bariatric surgery results for persons aged ≥60 years; but data are limited though increasingly accumulating for the ≥65-year-old population. Laparoscopic Roux-en-Y-gastric bypass and sleeve gastrectomy have been the preferred bariatric procedures for older adults with obesity, as for younger patients. This review summarizes the safety and efficacy of bariatric surgery for individuals aged ≥65 years with obesity, and the efforts that have been invested to improve the perioperative and long-term consequences.
Effect of age on quality of life after gastric bypass: data from the Scandinavian Obesity Surgery Registry
2022, Surgery for Obesity and Related Diseases
Citation Excerpt :
In conclusion, our data from this study show that, in similarity to younger individuals, older patients display marked and sustained improvements in important aspects of HRQoL after surgery-induced weight loss up to 5 years. This corroborates previous findings that bariatric surgery in this group of patients is associated with similar rates of complications and resolution of obesity-associated co-morbidities as in younger patients [4,8,30]. Taken together, this further supports that older patients should not be excluded from bariatric surgery solely based on age.
Whether patients aged 60 years or older should be recommended bariatric surgery is still controversial.
To assess the effect of age on health-related quality of life (QoL) over time after gastric bypass.
Data from the Swedish national registry for bariatric surgery.
Data of 57,215 patients undergoing gastric bypass were retrieved from the Scandinavian Obesity Surgery Register with a follow-up rate at 1,2, and 5 years at 89%, 69%, and 59%, respectively. Patients were divided into 5-years age intervals. Odds ratios for the relative mean changes in QoL were compared by logistic regression.
Preoperatively, patients aged 60 years or older scored better on mental aspects (Mental Component Summary score, MCS) of RAND-36 (Short Form Health Survey (higher values better)) as well as OP (Obesity related Problem scale (lower values better)) better than the entire cohort of patients (MCS: mean [95% CI], 46.2 [45.5–46.9] versus 43.5 [43.4–43.7], respectively; OP: mean [95% CI], 55.3 [54.0–56.6] versus 64.1 [63.9–64.4], respectively), whereas the Physical Component Summary (PCS) scores of patients aged 60 years or older were lower (mean [95% CI], 32.3 [31.7–32.8] for the ≥60-yr cohort versus 36.4 [36.2-36.5] for the entire cohort; P < .001 for all). In all age groups, MCS was improved at 1 and 2 years but decreased to baseline at 5 years. The postoperative improvements in PCS and OP were sustained in all age groups. Although the relative increases for PCS and OP in patients aged ≥60 years were somewhat lower compared with the entire cohort at 5 years, the values were well above baseline levels (mean [95% CI], 41.0 [40.0–42.0] versus 32.3 [31.7–32.8] and 22.2 [20.3–24.0] versus 55.3 [54.0–56.6], respectively; P < .001).
Mental QoL is transiently improved after bariatric surgery without marked differences between age groups. However, patients aged ≥60 years report pronounced and sustained improvements in physical and obesity-specific QoL 5 years postoperatively. These observations support previous studies that older patients should not be denied bariatric surgery from a risk-benefit perspective, solely based on age.
Risk factors for postoperative bleeding in bariatric surgery
2022, Surgery for Obesity and Related Diseases
Citation Excerpt :
Increasing age was found to be an independent predictor for postoperative bleeding following bariatric surgery. Age >50 years was associated with a higher rate of postoperative complications in gastric bypass surgery [19], and bleeding also was found to be more prevalent in patients older than 45 years in previous studies [20]. Differences are most likely caused by added co-morbidities with age not measured or corrected for in this model.
Postoperative bleeding remains a relatively common complication following bariatric surgery and may lead to morbidity and even mortality.
To develop a prediction model to identify patients at risk for postoperative bleeding.
Rode Kruis Ziekenhuis, Beverwijk, the Netherlands. Based on Dutch nationwide obesity audit data.
Patients undergoing primary bariatric surgery were selected from January 2015 to December 2020 from the Dutch Audit for Treatment of Obesity. The primary outcome was postoperative bleeding within 30 days. Assessed predictors included patient factors and operative data. A prediction model was developed using backward stepwise logistic regression. Internal validation was performed using bootstrapping techniques.
A total of 59,055 patients were included; 13,399 underwent a sleeve gastrectomy, and 45,656 underwent a gastric bypass procedure. Postoperative bleeding occurred in 1.5%. The following predictors were identified: male patients (odds ratio [OR] = 1.40; 95% confidence interval [CI]: 1.21–1.63), patients >45 years of age (OR = 1.50; 95% CI: 1.29–1.76), body mass index <40 kg/m² (OR = 1.22; 95% CI: 1.06–1.41), cardiovascular disease (OR = 1.36; 95% CI: 1.17–1.57), and sleeve gastrectomy (OR = 1.43; 95% CI: 1.24–1.67). Area under the curve for the model was .612. Following bootstrapping for internal validation, a correction of .9817 was applied.
A clinical decision rule was designed to assess the risk of postoperative bleeding in patients undergoing bariatric surgery. If 3 or more risk factors are present, there is an increased risk for postoperative bleeding. The model can aid in clinical decision-making: implementing extra preventative measures in high-risk patients. External validation is needed to further develop the model.
Is laparoscopic bariatric surgery as safe and effective before and after age 60? Results from a propensity-score analysis
2022, Surgery for Obesity and Related Diseases
Citation Excerpt :
Whether bariatric surgery should be performed on elderly people is still controversial. The risk of perioperative morbidity and mortality is an important issue, especially with elderly patients [9,11,19]. In this study, the primary endpoint included the prevalence of severe postoperative complications as defined by any complication occurring within 90 days after surgery ≥3 according to the Clavien-Dindo classification [22].
Patients over 60 years old undergoing bariatric surgery is still increasing.
First, to assess the impact of age (>60 years) on the 90-day morbidity and mortality of both laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG), and second, to determine the effectiveness of surgical weight loss and resolution of obesity-related comorbidities for patients 60 years of age and older over a 2-year period.
Bicentric study from University Hospital of Caen and Memorial Hospital of Saint Lô, France.
This is a retrospective review of a prospectively maintained database of patients with morbid obesity undergoing laparoscopic bariatric surgery from October 2005 to April 2019. Patients 60 years of age and older were defined as cases (elderly group [EG], n = 137), and patients younger than 60 years of age were defined as controls (young group [YG], n = 1544). The primary endpoint of the study was the prevalence of severe postoperative complications within 90 days of surgery determined by a propensity-score-matching (PSM) analysis.
The PSM population included 133 patients in the EG who were matched 1:2 with 266 patients in the YG. There was no mortality in either group. Although not significant (with an absolute difference of 4.5% between the EG and the YG), the odds of severe postoperative complications were 2.5 times higher in the EG than in the YG (7.5% versus 3.0%, P = .053). At 90 days postoperatively, the prevalences of overall morbidity (31.6% versus 22.9%, P = .044), leakage (5.3% versus 1.1%, P = .026), and reoperation (5.3% versus 1.1%, P = .026) were significantly higher in the EG than in the YG.
This propensity-matched study suggests that laparoscopic bariatric surgery is probably an effective treatment in obese elderly patients (EPs) in terms of weight loss and resolution of comorbidities. However, the EP should be warned of the increased risk of severe postoperative complications within 90 days, including leakage and reoperation rates, especially after RYGB.
Comment on: Prevalence and impact of acid-related symptoms and diarrhea in patients undergoing Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch
2020, Surgery for Obesity and Related Diseases
Predictors and outcomes of leak after Roux-en-Y gastric bypass: an analysis of the MBSAQIP data registry
2019, Surgery for Obesity and Related Diseases
Gastrointestinal leak is one of the most severe postoperative complications after Roux-en-Y gastric bypass (RYGB), occurring in up to 2% of all patients. This has led to adoption of simpler procedures, such as sleeve gastrectomy, which have improved safety profiles but potentially less effective long-term metabolic outcomes. Yet, in contrast to sleeve gastrectomy, a paucity of modern literature exists regarding predictors of leak for RYGB.
The purpose of this study was to examine gastrointestinal leak in patients undergoing RYGB using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement data registry.
We identified all Metabolic and Bariatric Surgery Accreditation and Quality Improvement patients who underwent RYGB in 2015 and 2016. Primary outcomes of interest include identifying the prevalence, impact, and predictors of leak in RYGB patients. Our secondary outcomes of interest include characterizing overall complication rates in RYGB patients. Univariate analysis of pre-, intra-, and postoperative variables was performed using Χ² tests for categoric data and independent sample t test for continuous data. A nonparsimonious multivariable logistic regression model was then developed to determine predictive factors for development of leak.
All centers belonging to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement data registry.
A total of 77,596 patients underwent RYGB from 2015 to 2016. The majority of patients were female (79.8%), white (75.9%), and underwent laparoscopic RYGB (89.7%). The mean age of patients was 45.2 years (standard deviation 11.9) with a mean body mass index of 46.3 kg/m² (standard deviation 8.17). Complication rates for RYGB were low with a mortality of .16% and a total complication rate of 7.5%. A total of 476 leaks were identified with an overall leak rate of .6% and a mortality of 1.5%. Leak was associated with a statistically significant increase in all complications as well as readmission, reoperation, and mortality rates at 30 days. Multivariable logistic regression analysis revealed the following statistically significant independent predictors of leak: body mass index, age, operative length, American Society of Anesthesiologists score >3, prior pulmonary embolus, and partially dependent functional status. Albumin was the only independent protective variable after adjusting for confounders and interactions.
Using the robust Metabolic and Bariatric Surgery Accreditation and Quality Improvement database, we found RYGB to be a safe procedure with low morbidity and mortality. The overall leak rate was .6% with leak significantly increasing all other complications, readmission, reoperation, and mortality rates at 30 days. Logistic regression identified prior pulmonary embolus and partially dependent functional status as the 2 largest predictors of leak while increased albumin was the only protective factor. Optimizing preoperative nutrition and strength in these patients through structured multidisciplinary programs may therefore have a role in the ongoing improvement of outcomes after RYGB.

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^☆: This study was supported by the Erling-Persson Family Foundation.

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Original articleImpact of age on risk of complications after gastric bypass: A cohort study from the Scandinavian Obesity Surgery Registry (SOReg)☆

Abstract

Background

Objective

Setting

Methods

Results

Conclusions

Section snippets

The Scandinavian Obesity Registry

Patients and operative data

Discussion

Conclusion

Disclosures

Surg Obes Relat Dis

Surg Obes Relat Dis

Surg Obes Relat Dis

Excess deaths associated with underweight, overweight, and obesity

JAMA

A review of the safety and efficacy of bariatric surgery in adults over the age of 60: 2002-2013. J Am Assoc

Nurse Pract

Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures

JAMA

Risk factors associated with mortality after Roux-en-Y gastric bypass surgery

Ann Surg

Original article
Impact of age on risk of complications after gastric bypass: A cohort study from the Scandinavian Obesity Surgery Registry (SOReg)☆