Impact of age on morbidity and mortality following bariatric surgery

Maloney, Sean R.; Dugan, Nicholas; Prasad, Tanushree; Colavita, Paul D.; McKillop, Iain H.; Gersin, Keith S.; Kuwada, Timothy S.; Barbat, Selwan; Roberts, Alexandra J.; Nimeri, Abdelrahman

doi:10.1007/s00464-019-07201-2

Cited by 10 publications

(3 citation statements)

References 30 publications

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“…We projected that this aging trend will continue over the next decade, with the median patient age expected to reach 61.5 years by 2030, marking a 5.5-year increase from 2020 (Knoedler et al, 2023). These findings may directly impact clinical care since aging and frailty are interwoven with multiple studies highlighting age and frailty as surgical risk factors (Aquina et al, 2017;Chung et al, 2021;Cooper et al, 2016;Maloney et al, 2020;Matsuo et al, 2018;Østergaard et al, 2020;Panayi et al, 2021;Panayi et al, 2022). Therefore, it becomes imperative to optimize the management of elderly surgical patients, as the aging population seeking surgery continues to grow.…”

Section: Discussionmentioning

confidence: 99%

The combined risk predictive power of frailty and hypoalbuminemia in free tissue flap reconstruction: A cohort study of 34,571 patients from the NSQIP database

Panayi,

Knoedler,

Matar

et al. 2024

Microsurgery

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IntroductionSignificant morbidity and mortality are hallmarks of the functional decline seen in physically frail patients. The modified frailty index 5 (mFI‐5) represents a risk predictor score that has been validated as a comorbidity‐based scale in surgery. Serum albumin levels of <3.5 g/dL (hypoalbuminemia) have also been implicated with poor postoperative outcomes. However, the association between these two parameters remains to be investigated. We aimed to elucidate the interdependence of preoperative albumin levels and frailty, as evaluated by the mFI‐5 score, and its reliability to prognosticate postoperative results in free flap reconstruction (FFR).MethodsWe conducted a multicenter, retrospective cohort study and accessed the ACS National Surgical Quality Improvement Program (ACS‐NSQIP) from 2008 to 2021. We identified all adult patients (≥18 years of age) who underwent a FFR. We extracted perioperative data and lab values including albumin. Multivariable linear and logistic regression analyses were performed to identify independent risk predictors. Main outcomes involved mortality, length of hospital stay, reoperation, medical and surgical complications, and discharge destination within the 30‐day postoperative period.ResultsA total of 34,571 patients were included in the study, with an average age of 53.9 years (standard deviation [SD] 12.2) and an average body mass index (BMI) of 28.8 (SD 6.1). Of these patients, 7484 were male (21.6%), whereas 22,363 (64.7%) had no frailty (mFI = 0). Additionally, 9466 patients had a frailty score of 1 (27.4%), 2505 had a score of 2 (7.2%), 226 had a score of 3 (0.7%), and 11 had a score of 4 or higher (0.0%). Albumin levels were available for 16,250 patients (47.0%), and among them, 1334 (8.2%) had hypoalbuminemia. Regression analyses showed that higher mFI scores were independent predictors of any, surgical, and medical complications, as well as increased rates of reoperations, unplanned readmissions, and prolonged hospital stays. Hypoalbuminemia independently predicted any, surgical, and medical complications, and higher mortality, reoperation, and longer hospital stay. When both frailty and albumin levels (mFI‐5 and albumin) were considered together, this combined assessment was found to be a more accurate predictor of all major outcomes (any, medical and surgical complications, mortality, and reoperation). Further, our analysis identified a weak negative correlation between serum albumin levels and mFI scores (Spearman R: −.1; p < .0001).ConclusionIn conclusion, this cohort study highlights the association of hypoalbuminemia with adverse postoperative outcomes, including those not directly related to frailty. Simultaneously, higher mFI scores independently predicted outcomes not associated with hypoalbuminemia. Stemming from these findings, we recommend considering both serum albumin levels and frailty in patients receiving FFR. This perioperative algorithm may help provide more individualized planning including multidisciplinary care and pre and posthabilitation.

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Section: Discussionmentioning

confidence: 99%

The combined risk predictive power of frailty and hypoalbuminemia in free tissue flap reconstruction: A cohort study of 34,571 patients from the NSQIP database

Panayi,

Knoedler,

Matar

et al. 2024

Microsurgery

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“…Such age-related decline in health aggravates surgical vulnerability and predisposes to perioperative complications. Numerous studies identified age and frailty as surgical risk factors 16 – 23 . The susceptibility of the surgical geriatric sub-population, therefore, necessitates specialized management.…”

Section: Discussionmentioning

confidence: 99%

The surgical patient of yesterday, today, and tomorrow—a time-trend analysis based on a cohort of 8.7 million surgical patients

Knoedler

Matar

Friedrich

et al. 2023

International Journal of Surgery

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Background: Global healthcare delivery is challenged by the aging population and the increase in obesity and type 2 diabetes. The extent to which such trends affect the cohort of patients the authors surgically operate on remains to be elucidated. Comprising of 8.7 million surgical patients, the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database can be analyzed to investigate the echo of general population dynamics and forecast future trends. Material and methods: The authors reviewed the ACS-NSQIP database (2008–2020) in its entirety, extracting patient age, BMI, and diabetes prevalence. Based on these data, the authors forecasted future trends up to 2030 using a drift model. Results: During the review period, median age increased by 3 years, and median BMI by 0.9 kg/m2. The proportion of patients with overweight, obesity class I, and class II rates increased. The prevalence of diabetes rose between 2008 (14.9%) and 2020 (15.3%). The authors forecast the median age in 2030 to reach 61.5 years and median BMI to climb to 29.8 kg/m2. Concerningly, in 2030, eight of ten surgical patients are projected to have a BMI above normal. Diabetes prevalence is projected to rise to 15.6% over the next decade. Conclusion: General population trends echo in the field of surgery, with the surgical cohort aging at an alarmingly rapid rate and increasingly suffering from obesity and diabetes. These trends show no sign of abating without dedicated efforts and call for urgent measures and fundamental re-structuring for improved future surgical care.

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“…Altogether, these findings can aid in counseling and shared decisionmaking for patients weighing the potential benefits of bariatric surgery against its associated risks. Although the risk of postoperative complications following bariatric surgery is relatively low [30][31][32], Maloney et al [32] have noted an increase of such events in patients older than 45 years relative to their younger counterparts. We conducted spline analysis in patients aged 45 years and above and found a threshold of 59, indicating the age with the most significant increase in risk of total complications.…”

Section: Discussionmentioning

confidence: 99%

Bariatric surgery outcomes in geriatric patients: a contemporary, nationwide analysis

Mabeza

Mao

Maynard

et al. 2022

Surgery for Obesity and Related Diseases

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Impact of age on morbidity and mortality following bariatric surgery

Cited by 10 publications

References 30 publications

The combined risk predictive power of frailty and hypoalbuminemia in free tissue flap reconstruction: A cohort study of 34,571 patients from the NSQIP database

The combined risk predictive power of frailty and hypoalbuminemia in free tissue flap reconstruction: A cohort study of 34,571 patients from the NSQIP database

The surgical patient of yesterday, today, and tomorrow—a time-trend analysis based on a cohort of 8.7 million surgical patients

Bariatric surgery outcomes in geriatric patients: a contemporary, nationwide analysis

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