Incidence, Indications, and Predictive Factors for ICU Admission in Elderly, High-Risk Patients Undergoing Laparoscopic Sleeve Gastrectomy
- 19 Downloads
Obesity affects the elderly, leading to increased prevalence of age- and obesity-associated comorbidities. There are no guidelines for indications and risk assessment for the elderly undergoing bariatric surgery.
To determine the incidence, indications, and outcomes of planned ICU admission in elderly, high-risk patients after laparoscopic sleeve gastrectomy (LSG) and to assess if preoperative risk factors for planned postoperative ICU admission in elderly patients undergoing LSG could be predicted preoperatively.
Retrospective review of prospectively collected data for all patients aged ≥ 60 years who underwent LSG (2011–2016) at Hamad General Hospital in Qatar.
We followed up 58 patients aged 60–75 years for 28 ± 17 months. About 77.6% of patients were in the intermediate-risk group of the Obesity Surgery Mortality Risk Score (OS-MRS). Fourteen patients (24%) required ICU admission for 2 ± 1.2 days; all patients belonged to the American Society of Anesthesiologists (ASA) III class and intermediate to high risk on OS-MRS. There were no reported mortalities. The mean body mass index (BMI) decreased from 49 ± 10.6 to 37.6 ± 10.1 kg/m2. The number of patient comorbidities (OR, 1.43; 95% CI, 1.03–1.99) and the diagnosis of obstructive sleep apnea (OSA; OR, 7.8; 95% CI, 1.92–31.68) were associated with planned ICU admission.
Elderly patients undergoing LSG usually have excellent postoperative course despite the associated high risk and the required ICU admission. The number of comorbidities, diagnosis of OSA, and ASA score are possible clinically significant predictive factors for the need of post-LSG ICU admission.
KeywordsLaparoscopic sleeve gastrectomy Elderly Obesity Surgery Mortality Risk Score Obstructive sleep apnea
We would like to acknowledge Professor Luigi Angrisani (Director of General, Laparoscopic, Emergency Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy), who offered invaluable insight, support, and supervision to finalize this article. We acknowledge the following doctors: Helmuth Billy (Director of Bariatric and Metabolic Surgery, St. John’s Regional Medical Center, Oxnard, CA, USA) and Alan Saber (Clinical Professor of Surgery—Icahn School of Medicine at Mount Sinai, USA) for their contribution as visiting operating surgeons of some cases; Kassim Al Anee and Atchyuta Vegesna (Senior Bariatric Anesthesia Consultants, HGH, Qatar) for their major role in patients’ management.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
The current study was conducted after the research protocol was approved by the institutional review board of the Medical Research Centre at Hamad Medical Corporation. For this type of study, formal consent is not required.
- 13.Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring) 2013. 21(0 1):S1–27.Google Scholar
- 17.Sabah SA, Alsharqawi N, Al-Mulla A, et al. Laparoscopic sleeve gastrectomy in patients aged 55 and older. Adv Obes Weight Manag Control. 2016;4(1):00079.Google Scholar
- 27.Ritz P, Topart P, Benchetrit S, et al. Benefits and risks of bariatric surgery in patients aged more than 60 years. Surg Obes Relat Dis. 2014;14:4–5.Google Scholar