Background

The elderly patients are dubbed to have worse postoperative outcomes than their younger counterparts. The cut-off age defining the elderly in bariatric surgery has not been characterized. The aim of this study was to determine the age cut-off that best describes the elderly patients at which the outcome worsens after primary bariatric surgery.

Methods

The MBSAQIP database for years 2015 and 2016 was used to identify primary Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) patients. Patients ≥30-years old and with a body mass index of 30-70 kg/m2 were included. The receiver operator characteristic (ROC) curves were plotted to assess the cut-off age for the 30-day postoperative mortality and the composite serious morbidity.

Results

A total of 224,204 patients were included in the study, of which 156,768 (69.9%) had SG and 67436 (30.1%) had RYGB. The median age was 46.2-years (interquartile range, 39-55) with a female predominance of 177,114 (79%) patients. The age range between 47 and 50 had the highest Youden index to predict early postop mortality and serious morbidity (Table 1). However, the c-statistics were consistently <0.7 indicating poor discrimination.

Conclusions

ROC curve analysis failed to point-out a cut-off age corresponding to a point for worsening of early postoperative outcomes by increasing age. This might be due to appropriate elderly patient-selection practice in the MBSAQIP-accredited centers. Findings of this study would suggest that patients should not be denied bariatric surgery based on their chronological age, rather would be assessed for functional capacity and physiologic reserve.