Evaluating postoperative conversion trends in the elderly: an Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-based analysis of bariatric surgery outcomes.
Juan S Barajas-Gamboa, Gabriela Restrepo-Rodas, Valentin Mocanu, Thomas Shin, Gustavo Romero-Velez, Andrew T Strong, Salvador Navarrete, John Rodriguez, Ricard Corcelles, Matthew Kroh, Jerry T Dang
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Abstract
Background: Bariatric surgery is increasingly common among elderly patients, yet postoperative conversion trends remain underexplored in this population.
Objectives: Utilizing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, this study aims to provide a comprehensive analysis of conversion trends postbariatric surgery in the elderly.
Setting: MBSAQIP national database.
Methods: We conducted a retrospective analysis of conversional bariatric surgeries reported in the MBSAQIP database from 2020 to 2022. The percentage of cases, demographics, indications, complications, and mortality for conversional procedures in elderly patients were analyzed. Elderly was defined as patients older than 65 years of age.
Results: Out of 51,138 conversional bariatric surgery patients, 3746 elderly patients underwent conversions during 2020-2022. The primary surgical procedures included 1479 (39.4%) sleeve gastrectomy (SG), 2086 (55.6%) adjustable gastric banding (AGB), and 181 (4.8%) vertical banded gastroplasty (VBG) conversions, respectively. The mean age was 68.43 ± 3.0 for AGB, 68.44 ± 3.0 years for the SG, and 68.81 ± 3.0 for the VBG. Baseline comorbidities were similar between groups. The most common indications in all groups were weight gain and gastroesophageal reflux disease (GERD). AGBs were converted mostly to SG (57.6%), primary SG and VBG were converted mostly to Roux-en-Y gastric bypass (RYGB) (91.9% and 92.8%, respectively). Conversions of AGB to RYGB were associated with a higher rate of serious complications and death than conversions of AGB to other techniques (P = .02). Conversions of VBG to RYGB had the highest rate of serious complications (18.4% versus 7.6% for VBG to SG) and death (4.1% versus 0% for VBG to SG), though these differences were not statistically significant (P = .32 and P = .45, respectively).
Conclusions: Our results suggest different patterns for conversional bariatric surgery in the elderly. This study shows that procedures were safe, although complication rates and mortality were higher in the VBG conversion procedures.
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