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Advanced Age as an Independent Predictor of Perioperative Risk after Laparoscopic Sleeve Gastrectomy (LSG)

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Abstract

Background

While the safety of many bariatric procedures has been previously studied in older patients, we examine the effect of advancing age on medical/surgical complications in laparoscopic sleeve gastrectomy, a relatively unstudied procedure but that is trending upwards in use.

Methods

Patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (RYGB) were extracted from the National Surgical Quality Improvement Program 2005–2012 database. Pre- and postoperative variables were analyzed using chi-square and student t test as appropriate to determine the comparative safety of LSG to RYGB in the elderly. Multivariate regression modeling was used to evaluate whether age is associated with adverse 30-day events following LSG.

Results

Of the patients that met the inclusion criteria, 56,664 (84 %) patients underwent RYGB and 10,835 (16 %) underwent LSG. In the LSG cohort, incidence of overall complications, medical complications, and death significantly increased with increasing age (p < 0.05). No statistically significant differences in rates of 30-day complications, return to the OR, and mortality exist between RYGB and LSG cohorts in patients older than 65 years. The age group of over 65 years independently predicted increased risk for overall and medical complications (OR, 1.748; OR, 2.027). Notably, age was not significantly associated with surgical complications in LSG.

Conclusion

In this large, multi-institutional study, advanced age was significantly associated with overall and medical complications but not surgical complications in LSG. Our findings suggest that the risk conferred by advancing age in LSG is predominantly for medical morbidity and advocate for improved perioperative management of medical complications. LSG may be the preferable option to RYGB for elderly patients as neither procedure is riskier with regards to 30-day morbidity while LSG has been shown to be safer with regards to long-term reoperation and readmission risk.

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Financial Support

This particular research received no internal or external grant funding.

Ethical Approval

De-identified patient information is freely available to all institutional members who comply with the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Data Use Agreement. The Data Use Agreement implements the protections afforded by the Health Insurance Portability and Accountability Act of 1996 and the ACS-NSQIP Hospital Participation Agreement, and conforms to the Declaration of Helsinki.

Disclaimer

The NSQIP and the hospitals participating in the NSQIP are the source of the data used herein; they have not been verified and are not responsible for the statistical validity of the data analysis, or the conclusions derived by the authors of this study.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair Street, Galter Suite 19-250, Chicago, IL, 60611, USA

    Charles Qin, Apas Aggarwal & John Y. S. Kim

  2. Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Bill Luo

  3. Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Gildasio De Oliveira

Authors
  1. Charles Qin
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  2. Bill Luo
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  3. Apas Aggarwal
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  4. Gildasio De Oliveira
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  5. John Y. S. Kim
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Corresponding author

Correspondence to John Y. S. Kim.

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Qin, C., Luo, B., Aggarwal, A. et al. Advanced Age as an Independent Predictor of Perioperative Risk after Laparoscopic Sleeve Gastrectomy (LSG). OBES SURG 25, 406–412 (2015). https://doi.org/10.1007/s11695-014-1462-0

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  • DOI: https://doi.org/10.1007/s11695-014-1462-0

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