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Risk of Poor Outcomes From Bariatric Surgery Greater in Elderly

Posted: Thursday, December 07, 2006

For patients aged 65 years and older, adverse event rates exceeded 20%, and in-house mortality was 3.2%.

The rate of adverse events and mortality after bariatric surgery is higher in elderly patients, with male sex and electrolyte disorders as independent risk factors.

"Medicare assembled a medical care advisory committee to review the available literature supporting application of bariatric surgery to the Medicare population. "The committee concluded that there were insufficient data to arrive at recommendations relevant to the Medicare patients. The major issues needing clarification are the perioperative safety for weight loss operations and long-term weight loss and comorbidity control for older and other Medicare-eligible patients."

Using a national sample of hospitalized patients in the United States, the investigators identified 25,428 bariatric procedures performed in adult patients in 2001 and 2002.

Logistic regression revealed that independent risk factors for bariatric surgery mortality were age, male sex, electrolyte disorders, and congestive heart failure.

Adverse outcomes increased nearly linearly as a function of age, with a sharp increase after age 65 years. For patients aged 65 years and older, adverse event rates exceeded 20%, and in-house mortality was 3.2%. Most Medicare patients who had bariatric surgery were younger than 65 years and had a much greater disease burden than did non-Medicare patients.

"Age, male sex, electrolyte disorders, and congestive heart failure were independent risk factors for bariatric surgical mortality," the authors write. "Limiting bariatric surgical procedures to those younger than 65 years is warranted because of the high morbidity and mortality associated with these operations in older patients."

Study limitations include accepting older patients for surgery only if they were optimal candidates, imprecise disease and procedure coding, and lack of detailed patient-specific information.

"While the study is quite helpful in assessing operative risk stratification, it does not provide any long-term follow-up to assess benefits or to determine how much risk is appropriate," Dr. Deveney writes. "We need to look at benefits in the vast majority of patients who survive their bariatric procedure to determine what is an appropriate risk for a given patient.

Source: Diabetes In Control: Arch Surg. 2006;141:1115-1120