- •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.
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.
To develop a predictive model, GeriBari, for serious complications in geriatric patients after bariatric surgery.
Multiple accredited bariatric surgery centers in the United States and Canada.
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.
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%.
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.
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Published online: September 11, 2022
Accepted: August 30, 2022
Received: June 15, 2022
Source of funding: None.
© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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- 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 .