Background

Elderly patients have a higher burden of disease and 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 laparoscopic bariatric surgery.

Methods

This was a retrospective cohort study of the MBSAQIP database, which collects data specific to bariatric surgery with 30-day outcomes from 868 centers. Individuals ≥ 65 years undergoing 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 using 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 31,505 geriatric patients underwent LRYGB (26.6%) or LSG (73.4%). Overall, 1,483 (4.7%) experienced a complication, which included bleeding (1.6%), reoperation (1.5%), reintervention (1.4%), unplanned intubation (0.4%), and pneumonia (0.4%). Mortality was higher in the geriatric patients compared to younger patients (0.27% vs 0.08%). GeriBari consists of eleven factors that predicted serious complications and stratified individuals into high (>6%) and low risk (<6%) groups (Figure 1). This tool accurately predicted events in the validation cohort with an area under the receiver operating characteristic curve of 0.65.

Conclusions

GeriBari stratifies geriatric individuals undergoing bariatric surgery based on 30-day serious complication risk. Stratifying low- and high-risk geriatric patients for adverse events allows for informed clinical decision-making prior to bariatric surgery.