Short-term safety and efficacy of revision or conversion metabolic and bariatric surgery in older adults: an analysis of the MBSAQIP database.

BACKGROUND

A subset of older adults who undergo metabolic and bariatric surgery (MBS) eventually requires revision or conversion of their index MBS procedure. However, the relative safety of revision/conversion MBS in the older population as compared to younger adults is unclear.

METHODS

We conducted a retrospective comparative analysis of postoperative outcomes of revision/conversion MBS in patients 18-65 years of age (Younger) versus > 65 years of age (Older) using the 2020-2024 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Our primary outcome was 30-day incidence of major complications, defined as Clavien-Dindo Grade ≥ 2.

RESULTS

From a total of 118,208 revision/conversion MBS procedures, 8042 (6.8%) were in the Older age group. Older patients had a lower BMI, were more likely to be male, and had a greater incidence of comorbid medical conditions at baseline compared to younger patients. After adjusting for patient and procedure-level covariates, older patients had a significantly greater odds of major complications (adjusted OR 1.21 [95% CI 1.11-1.32], p < 0.0001), anastomotic or staple line leak (adjusted OR 1.68 [95% CI 1.31-2.13], p < 0.0001), and reoperation (adjusted OR 1.17 [95% CI 1.02-1.33], p = 0.026). Older patients also had a longer average operative time (Mean Difference (MD) 12.05 min [95% CI 10.48-13.62], p < 0.0001), length of hospital stay (MD 0.32 days [95% CI 0.27-0.37], p < 0.0001), and a lower change in BMI at 30 days (MD 0.1 kg/m2 lower change in BMI [95% CI 0.04-0.15], p = 0.0003). There were no differences between the two age groups in odds of re-intervention or readmission at 30 days.

CONCLUSION

Based on MBSAQIP data, revision/conversion MBS is associated with a significantly greater risk of morbidity in older patients as compared to younger adults. These findings suggest that revision/conversion MBS should be offered in the > 65 age group with careful consideration of patient factors and closer perioperative monitoring to optimize postoperative outcomes.