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The Impact of Age and Medicare Status on Bariatric Surgical Outcomes
Edward H. Livingston, MD;
Joshua Langert, BA
Arch Surg. 2006;141:1115-1120.
Hypothesis Medicare status and increasing age are associated with poor outcomes from bariatric surgical procedures.
Design Survey.
Setting National sample of hospitalized patients in the United States.
Patients and Intervention Adult patients undergoing bariatric surgery in 2001 and 2002.
Main Outcome Measures Mortality and adverse events.
Results We assessed 25 428 bariatric procedures with logistic regression, finding that age (odds ratio, 1.04; 95% confidence interval, 1.02-1.07), male sex (odds ratio, 2.45; 95% confidence interval, 1.48-4.03), electrolyte disorders (odds ratio, 13.91; 95% confidence interval, 8.29-23.33), and congestive heart failure (odds ratio, 4.96; 95% confidence interval, 2.52-9.77) were independent risk factors for bariatric surgery mortality. Adverse outcomes increased as a function of age in a nearly linear fashion, with a steep increase after the age of 65 years. Most Medicare patients undergoing these operations were younger than 65 years and had a much greater disease burden than non-Medicare patients.
Conclusions Age, male sex, electrolyte disorders, and congestive heart failure were independent risk factors for bariatric surgical mortality. Limiting bariatric surgical procedures to those younger than 65 years is warranted because of the high morbidity and mortality associated with these operations in older patients.
Author Affiliations: Veterans Affairs North Texas Health Care System and Division of Gastrointestinal and Endocrine Surgery, Southwestern Medical School, UT Southwestern Medical Center, Dallas.
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