title: Early morbidity and mortality of laparoscopic sleeve gastrectomy and gastric bypass in the elderly: a NSQIP analysis.
abstract: BACKGROUND
  Even though the U.S. population is aging, outcomes of bariatric surgery in the elderly are not well defined. Current literature mostly evaluates the effects of gastric bypass (RYGB), with paucity of data on sleeve gastrectomy (SG). The objective of this study was to assess 30-day morbidity and mortality associated with laparoscopic SG in patients aged 65 years and over, in comparison to RYGB.
  
  
  METHODS
  The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients aged 65 and over who underwent laparoscopic RYGB and SG between 2010 and 2011. Baseline characteristics and outcomes were compared. P value<.05 was considered significant. Odds ratios (OR) with 95% confidence interval (CI) were reported when applicable.
  
  
  RESULTS
  We identified 1005 patients. Mean body mass index was 44 ± 7. SG was performed in 155 patients (15.4%). The American Society of Anesthesiology physical classification of 3 or 4 was similar between the 2 groups (82.6% versus 86.7%, P = .173). Diabetes was more frequent in the RYGB group (43.2% versus 55.6%, P = .004). 30-day mortality (0.6% versus 0.6%, OR 1.1, 95% CI .11-9.49), serious morbidity (5.2% versus 5.6%, OR .91, 95% CI .42-0.96), and overall morbidity (9% versus 9.1%, OR 1.0, 95% CI .55-1.81) were similar.
  
  
  CONCLUSIONS
  In elderly patients undergoing laparoscopic bariatric surgery, SG is not associated with significantly different 30-day outcomes compared to RYGB. Both procedures are followed by acceptably low morbidity and mortality.
authors.affiliation: Division of Advanced Laparoscopic, Gastrointestinal and Endocrine Surgery, Department of Surgery, East Carolina University, Greenville, North Carolina. Electronic address: spaniolask@ecu.edu.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Thadeus L
authors.initials: TL
authors.lastname: Trus
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Gina L
authors.initials: GL
authors.lastname: Adrales
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Maureen T
authors.initials: MT
authors.lastname: Quigley
authors.affiliation: Division of Advanced Laparoscopic, Gastrointestinal and Endocrine Surgery, Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: William S
authors.initials: WS
authors.lastname: Laycock
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000401:mortality*; D015390:Gastric Bypass / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bariatric surgery; Elderly; NSQIP; Safety; Sleeve gastrectomy