The impact of age and medicare status on bariatric surgical outcomes

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.