Determining the age cut-off for increased surgical risk after Roux-en-Y gastric bypass in elderly patients: MBSAQIP 2015-2023 database analysis.

BACKGROUND

The elderly population in the United States is projected to double by 2050, along with obesity prevalence. Despite the increasing number of elderly patients undergoing bariatric surgery, evidence on perioperative safety remains limited and conflicting. Given concerns about higher perioperative morbidity, we compared 30-day outcomes and bariatric-specific complications after Roux-en-Y gastric bypass (RYGB) across age subgroups within the elderly bariatric population.

METHODS

Patients aged > 60 years who underwent RYGB were identified from the 2015 to 2023 MBSAQIP database. A 1:1 propensity score matching analysis using 22 preoperative characteristics was performed to compare 30-day outcomes between early versus late sexagenarians (60-64 vs. 65-69), early versus late septuagenarians (70-74 vs. 75-79), and late sexagenarians versus early septuagenarians (65-69 vs. 70-74).

RESULTS

We analyzed 45,775 RYGB patients. Except for Analysis 1, no differences were found in mortality, unplanned ICU admissions, or cardiopulmonary complications. After matching, Analysis 1 (n = 16,273) showed that late sexagenarians had higher rates of mortality, pulmonary complications, unplanned ICU admissions, blood transfusions, readmissions, and non-home discharge. In Analysis 2 (n = 2351; n = 600), late septuagenarians had higher rates of pulmonary complications, conversion to open, and non-home discharge. In Analysis 3 (n = 4307), early septuagenarians had higher rates of venous thromboembolism and non-home discharge.

CONCLUSIONS

RYGB is safe and feasible across elderly subgroups, with acceptable mortality, unplanned ICU admission, and cardiopulmonary complication rates. However, patients aged > 65 had significantly higher mortality and morbidity, suggesting this age as a threshold for increased perioperative risk. These findings highlight the importance of careful patient selection and preoperative optimization, particularly in patients older than 65 years.