Increased adverse outcomes after laparoscopic sleeve gastrectomy in older super-obese patients: analysis of American College of Surgeons National Surgical Quality Improvement Program Database

Background: Laparoscopic sleeve gastrectomy (SG) has become the most popular bariatric operation over the last decade. Extreme obesity and increasing age have been generally associated with higher risks of complications after bariatric surgery. The postoperative risk for complications after SG has not been previously presented according to simultaneous grouping of body mass index (BMI) and age. Objective: We aim to explore the association of age and BMI in determining the postoperative risk of SG from a national perspective. Setting: The American College of Surgeons National Surgical Quality Improvement Program database. Methods: We analyzed patient characteristics and operative outcomes of the 2010 to 2013 SG cohort available in the American College of Surgeons National Surgical Quality Improvement Program (N=21,131). Patients were grouped based on age and BMI: young-obese (N=10,291; <50 yr, BMI <0 kg/m(2); reference group), young-super-obese (N=3594; <50 yr and BMI >= 50 kg/m(2)), older-obese (N=5636; >= 50 yr, BMI <0 kg/m(2)), and older-super-obese (N=1610; >= 50 yr, BMI >= 50 kg/m(2)). Composite morbidity and/or mortality (M&M) was used as the primary outcome and risk-adjusted odds ratios (AOR[M&M]) were derived by logistic regression. M&M was a composite of surgical site, renal, neurologic, cardiac, thromboembolic, respiratory, septic and bleeding complications, unplanned readmissions, prolonged stay, and death. Results: Overall operative mortality was low (.1%) but significantly worse in older-super-obese patients (.37%; P =.005). M&M rates were lowest in young-obese (5.8%), similarly worse in young-super-obese (7.0%) and older-obese (7.0%), and highest for older-super-obese (10.1%; P <.001). After comprehensive covariate risk adjustment, the composite M&M outcome after SG was significantly increased (42%) only in older -super -obese patients (AOR =1.42 [1.16-1.73]), while older age alone (AOR =1.09 [.94-1.25]) and super obesity alone (AOR = 1.09 1.93-1.281) did not. Conclusions: Analysis of the American College of Surgeons National Surgical Quality Improvement Program showed that super obesity is associated with increased complications in older patients undergoing SG. Older-super-obese patients should be appropriately counseled about increased SG perioperative risks within the context of expected long-term benefits. (C) 2018 Published by Elsevier Inc. on behalf of American Society for Bariatric Surgery.