Highlights
- •Geriatric patients had higher rates of serious complications and death.
- •GeriBari consists of 12 factors that accurately predicted serious complications.
- •GeriBari is useful to stratify geriatric patients into low- and high-risk categories.
- •The sensitivity and specificity of GeriBari were 46.0% and 100.0%, respectively.
Abstract
Background
Geriatric patients have a greater risk of complications after bariatric surgery. The
objective of this study was to develop a tool to predict serious complications in
geriatric patients after minimally invasive bariatric surgery.
Objectives
To develop a predictive model, GeriBari, for serious complications in geriatric patients after bariatric surgery.
Setting
Multiple accredited bariatric surgery centers in the United States and Canada.
Methods
This was a retrospective cohort study of the Metabolic and Bariatric Surgery Accreditation
and Quality Improvement Program database, which collects 30-day bariatric surgery
outcomes from 868 accredited centers. Geriatric patients defined as those ≥65 years
old who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic
sleeve gastrectomy (LSG) were included. Characteristics associated with serious complications
were identified using univariate and multivariable analyses. A predictive model, GeriBari, was derived using a forward selection algorithm from operative years 2015, 2017,
and 2019. GeriBari’s robustness was tested against a validation cohort of subjects from operative years
2016 and 2018.
Results
A total of 40,199 geriatric patients underwent LRYGB (27.7%) or LSG (72.3%). Overall,
1866 (4.6%) experienced a complication, which included bleeding (1.6%), reoperation
(1.6%), reintervention (1.3%), unplanned intubation (.4%), and pneumonia (.4%). Mortality
was higher in the geriatric patients than that in younger patients (.27% versus .08%).
GeriBari consists of 12 factors that predicted serious complications and stratified individuals
into high- (>6%) and low-risk (<6%) groups. This tool accurately predicted events
in the validation cohort with sensitivity of 46.0% and specificity of 100%.
Conclusions
GeriBari enables preoperative risk stratification for 30-day serious complications in geriatric
patients undergoing bariatric surgery. Stratifying low- and high-risk geriatric patients
for adverse events allows for informed clinical decision-making prior to bariatric
surgery.
Keywords
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Article info
Publication history
Published online: September 11, 2022
Accepted:
August 30,
2022
Received:
June 15,
2022
Footnotes
Source of funding: None.
Identification
Copyright
© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Comment on: Predicting serious complications following bariatric surgery in geriatric patients: development of the GeriBari scoring tool using the MBSAQIP databaseSurgery for Obesity and Related DiseasesVol. 19Issue 3
- PreviewAs the rates of obesity and life expectancy continue to rise, it is inevitable for bariatric surgeons to face more often the dilemma of efficacy and safety of metabolic surgery in the geriatric population. The recently published first randomized prospective trial comparing the safety of laparoscopic sleeve gastrectomy (SG) to laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients older than 65 years found a similar number of complications between the 2 procedures but a higher trend toward severe complications in the LRYGB group [1].
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