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Obesity Surgery

, Volume 28, Issue 9, pp 2603–2608 | Cite as

Incidence, Indications, and Predictive Factors for ICU Admission in Elderly, High-Risk Patients Undergoing Laparoscopic Sleeve Gastrectomy

  • Nesreen Khidir
  • Moamena EL-Matbouly
  • Mohammed Al Kuwari
  • Michel Gagner
  • Moataz Bashah
Original Contributions

Abstract

Background

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.

Objectives

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.

Methods

Retrospective review of prospectively collected data for all patients aged ≥ 60 years who underwent LSG (2011–2016) at Hamad General Hospital in Qatar.

Results

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.

Conclusion

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.

Keywords

Laparoscopic sleeve gastrectomy Elderly Obesity Surgery Mortality Risk Score Obstructive sleep apnea 

Notes

Acknowledgments

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.

Ethical Approval

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.

References

  1. 1.
    Angrisani L, Cutolo PP, Formisano G, et al. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 10-year results of a prospective, randomized trial. Surg Obes Relat Dis. 2013;9:405–13.CrossRefPubMedGoogle Scholar
  2. 2.
    Flegal KM, Kit BK, Orpana H, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systemic review and meta-analysis. JAMA. 2013;309:71–82.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Quirante FP, Montorfano L, Rammohan R, et al. Is bariatric surgery safe in the elderly population? Surg Endosc. 2017;31:1538–43.CrossRefPubMedGoogle Scholar
  4. 4.
    O’Keefe KL, Kemmeter PR, Kemmeter KD. Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery Center of Excellence. Obes Surg. 2010;20:1199–205.CrossRefPubMedGoogle Scholar
  5. 5.
    Wang Y, Yi X, Li Q, et al. The effectiveness and safety of sleeve gastrectomy in the obese elderly patients: a systematic review and meta-analysis. Obes Surg. 2016;26:3023–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Maciejewski ML, Livingston EH, Smith VA, et al. Survival among high-risk patients after bariatric surgery. JAMA. 2011;305:2419–26.CrossRefPubMedGoogle Scholar
  7. 7.
    Robert M, Pasquer A, Espalieu P, et al. Gastric bypass for obesity in the elderly: is it as appropriate as for young and middle-aged populations? Obes Surg. 2014;24:1662–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Morgan D, Ho K. The anaesthetic assessment, management and risk factors of bariatric surgical patients requiring postoperative intensive care support: a state-wide, five-year cohort study. Anaesth Intensive Care. 2016;44:237–44.PubMedGoogle Scholar
  9. 9.
    DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007;3:134–40.CrossRefPubMedGoogle Scholar
  10. 10.
    García-García ML, Martín-Lorenzo JG, Lirón-Ruiz R, et al. Failure of the obesity surgery mortality risk score (OS-MRS) to predict postoperative complications after bariatric surgery. A single-center series and systematic review. Obes Surg. 2017;27:1423–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Coblijn UK, Lagarde SM, de Raaff CA, et al. Evaluation of the obesity surgery mortality risk score for the prediction of postoperative complications after primary and revisional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12:1504–12.CrossRefPubMedGoogle Scholar
  12. 12.
    Giordano S, Victorzon M. Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging. 2015;10:1627–35.PubMedPubMedCentralGoogle Scholar
  13. 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
  14. 14.
    Soto FC, Gari V, de la Garza JR, et al. Sleeve gastrectomy in the elderly: a safe and effective procedure with minimal morbidity and mortality. Obes Surg. 2013;23(9):1445–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Leivonen MK, Juuti A, Jaser N, et al. Laparoscopic sleeve gastrectomy in patients over 59 years: early recovery and 12-month follow-up. Obes Surg. 2011;21(18):1180–7.  https://doi.org/10.1007/s11695-011-0454-6.CrossRefPubMedGoogle Scholar
  16. 16.
    Burchett MA, McKenna DT, Selzer DJ, et al. Laparoscopic sleeve gastrectomy is safe and effective in elderly patients: a comparative analysis. Obes Surg. 2015;25(12):222–8.  https://doi.org/10.1007/s11695-014-1421-9.CrossRefPubMedGoogle Scholar
  17. 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
  18. 18.
    Mathus-Vliegen EMH, Basdevant A, Finer N, et al. Prevalence, Pathophysiology, Health Consequences and treatment options of obesity in the elderly: a guideline. Obes Facts. 2012;5:460–83.CrossRefPubMedGoogle Scholar
  19. 19.
    De Stefano F, Zambon S, Giacometti L, et al. Obesity, muscular strength, muscle composition and physical performance in an elderly population. J Nutr Health Aging. 2015 Aug;19(7):785–91.CrossRefPubMedGoogle Scholar
  20. 20.
    Abbas M, Cumella L, Zhang Y, et al. Outcomes of laparoscopic sleeve gastrectomy and roux-en-Y gastric bypass in patients older than 60. Obes Surg. 2015;25:2251–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Gonzalez-Heredia R, Patel N, Sanchez-Johnsen L, et al. Does age influence bariatric surgery outcomes? Bariatr Surg Pract Patient Care. 2015;10(2):74–8.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Keren D, Matter I, Rainis T. Sleeve gastrectomy in different age groups: a comparative study of 5-year outcomes. Obes Surg. 2016;26(2):289–95.CrossRefPubMedGoogle Scholar
  23. 23.
    Luppi CR, Balague C, Targarona EM, et al. Laparoscopic sleeve gastrectomy in patients over 60 years: impact of age on weight loss and co-morbidity improvement. Surg Obes Relat Dis. 2015;11(2):296–301.CrossRefPubMedGoogle Scholar
  24. 24.
    Mizrahi I, Alkurd A, Ghanem M, et al. Outcomes of laparoscopic sleeve gastrectomy in patients older than 60 years. Obes Surg. 2014;24(6):855–60.CrossRefPubMedGoogle Scholar
  25. 25.
    Nagao Y, Diana M, Vix M, et al. Age impact on weight loss and glycolipid profile after laparoscopic sleeve gastrectomy: experience with 308 consecutive patients. Surg Endosc. 2014;28(3):803–10.CrossRefPubMedGoogle Scholar
  26. 26.
    Pequignot A, Prevot F, Dhahri A, et al. Is sleeve gastrectomy still contraindicated for patients aged≥60 years? A case-matched study with 24 months of follow-up. Surg Obes Relat Dis. 2015;11(5):1008–13.CrossRefPubMedGoogle Scholar
  27. 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
  28. 28.
    van Rutte PW, Smulders JF, de Zoete JP, et al. Sleeve gastrectomy in older obese patients. Surg Endosc. 2013;27(6):2014–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Livingston EH, Huerta S, Arthur D, et al. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;236:576–82.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Bariatric SurgeryHamad General HospitalDohaQatar
  2. 2.HMCDohaQatar
  3. 3.Department of General SurgeryHamad General HospitalDohaQatar
  4. 4.Department of SurgeryHopital du Sacre CoeurMontrealCanada
  5. 5.Weill Cornell Medical CollegeDohaQatar

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