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Bariatric Surgery in the Elderly Male Veteran Population: Low Readmission Rates and Successful Outcomes
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Poster Presentations / Surgery for Obesity and Related Diseases 12 (2016) S76–S232
organizations. We recommend that the academic programs gain more popularity on the social media sites to enhance better communication between the healthcare and patients
A5120
BARIATRIC SURGERY IN THE ELDERLY MALE VETERAN POPULATION: LOW READMISSION RATES AND SUCCESSFUL OUTCOMES Eric Kubat1; Nalani Grace1; Nina Bellatorre2; Dan Eisenberg1; 1 VA Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto CA; 2VA Palo Alto Health Care System San Jose CA Rates of obesity in the elderly population are increasing. Age, gender and weight related comorbidities might contribute to poor outcomes in bariatric surgery. We sought to evaluate a cohort of elderly Veterans undergoing bariatric surgery. After IRB approval, data were collected from a prospectively managed bariatric surgery database at an academic-affiliated, Veterans Affairs Medical Center. Primary bariatric cases in patients aged Z 60 years were identified. Data from this cohort was then extracted and analyzed. Bariatric surgery was performed in 286 patients between 20012015. A cohort was selected that included 76 patients who were older than 60 years (range 60-69) with a mean age of 63.6 years. Their mean BMI was 44.3 kg/m2, mean ASA 3 and gender makeup was 90% male. Preoperatively the majority of patients had type II diabetes 64.5% (49), hypertension 92.1% (70), obstructive sleep apnea 76.3% (58), hypercholesterolemia 85.5% (65), gastroesophageal reflux disease 53.9% (41) or osteoarthritis 69.7% (53). 63.2% (48) had a preoperative psychiatric diagnosis and 18.4% (14) had coronary artery disease that required preoperative intervention. Sleeve gastrectomy was performed in 54 patients (71%) and Roux-en-Y gastric bypass was performed in 22 patients (29%). All but two of the procedures were completed laparoscopically. The rate of early postoperative complication was 10.5%
(3 Clavien-Dindo grade II and 5 Clavien-Dindo grade III). The mean inpatient length-of-stay was 5.3 days. Thirty-day mortality was 0% and the 30-day readmission rate was 2.6%. Causes of readmission included anastomotic leak (1 patient) and pneumothorax following air travel home (1 patient). Percent Excess Body Mass Index Loss at 1, 3 and 5 years was 58.1%, 51.5% and 55.1%. Percent Total Weight Loss at 1, 3, and 5 years was 23.1%, 20.2% and 21.5%. Mean patient follow-up was 49.6 months. Percent follow-up at 1, 3 and 5 years was 100%, 97.5% and 90%. Successful bariatric surgery outcomes can be achieved in this unique population of elderly, predominantly male, Veterans with resultant low morbidity, low mortality and low readmission rates.
A5121
BARIATRIC SURGERY INSURANCE REQUIREMENTS INDEPENDENTLY PREDICT SURGERY DROPOUT Kaitlin Love1; J. Hunter Mehaffey2; Dana Safavian3; Bruce Schirmer2; Steven Malin4; Peter Hallowell2; Jennifer Kirby5; 1Department of Internal Medicine, University of Virginia, Charlottesville VA; 2Department of Surgery, University of Virginia, Charlottesville VA; 3University of Virginia School of Medicine, Charlottesville VA; 4Department of Kinesiology, University of Virginia, Charlottesville VA; 5Department of Endocrinology, University of Virginia, Charlottesville VA Background: Insurance companies have considerable pre-bariatric surgery requirements despite lack of evidence in improved outcomes. Previous studies have analyzed mandated diet programs' impact on surgical delay, surgical drop-out and weight loss preand post-operatively; however, this is the first study to look at the association between multiple insurance requirements and failure to undergo surgery. We hypothesize company specific requirements are independently predictive of progression to surgery and time to surgery from initial consultation.
Poster Presentations / Surgery for Obesity and Related Diseases 12 (2016) S76–S232
organizations. We recommend that the academic programs gain more popularity on the social media sites to enhance better communication between the healthcare and patients
A5120
BARIATRIC SURGERY IN THE ELDERLY MALE VETERAN POPULATION: LOW READMISSION RATES AND SUCCESSFUL OUTCOMES Eric Kubat1; Nalani Grace1; Nina Bellatorre2; Dan Eisenberg1; 1 VA Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto CA; 2VA Palo Alto Health Care System San Jose CA Rates of obesity in the elderly population are increasing. Age, gender and weight related comorbidities might contribute to poor outcomes in bariatric surgery. We sought to evaluate a cohort of elderly Veterans undergoing bariatric surgery. After IRB approval, data were collected from a prospectively managed bariatric surgery database at an academic-affiliated, Veterans Affairs Medical Center. Primary bariatric cases in patients aged Z 60 years were identified. Data from this cohort was then extracted and analyzed. Bariatric surgery was performed in 286 patients between 20012015. A cohort was selected that included 76 patients who were older than 60 years (range 60-69) with a mean age of 63.6 years. Their mean BMI was 44.3 kg/m2, mean ASA 3 and gender makeup was 90% male. Preoperatively the majority of patients had type II diabetes 64.5% (49), hypertension 92.1% (70), obstructive sleep apnea 76.3% (58), hypercholesterolemia 85.5% (65), gastroesophageal reflux disease 53.9% (41) or osteoarthritis 69.7% (53). 63.2% (48) had a preoperative psychiatric diagnosis and 18.4% (14) had coronary artery disease that required preoperative intervention. Sleeve gastrectomy was performed in 54 patients (71%) and Roux-en-Y gastric bypass was performed in 22 patients (29%). All but two of the procedures were completed laparoscopically. The rate of early postoperative complication was 10.5%
(3 Clavien-Dindo grade II and 5 Clavien-Dindo grade III). The mean inpatient length-of-stay was 5.3 days. Thirty-day mortality was 0% and the 30-day readmission rate was 2.6%. Causes of readmission included anastomotic leak (1 patient) and pneumothorax following air travel home (1 patient). Percent Excess Body Mass Index Loss at 1, 3 and 5 years was 58.1%, 51.5% and 55.1%. Percent Total Weight Loss at 1, 3, and 5 years was 23.1%, 20.2% and 21.5%. Mean patient follow-up was 49.6 months. Percent follow-up at 1, 3 and 5 years was 100%, 97.5% and 90%. Successful bariatric surgery outcomes can be achieved in this unique population of elderly, predominantly male, Veterans with resultant low morbidity, low mortality and low readmission rates.
A5121
BARIATRIC SURGERY INSURANCE REQUIREMENTS INDEPENDENTLY PREDICT SURGERY DROPOUT Kaitlin Love1; J. Hunter Mehaffey2; Dana Safavian3; Bruce Schirmer2; Steven Malin4; Peter Hallowell2; Jennifer Kirby5; 1Department of Internal Medicine, University of Virginia, Charlottesville VA; 2Department of Surgery, University of Virginia, Charlottesville VA; 3University of Virginia School of Medicine, Charlottesville VA; 4Department of Kinesiology, University of Virginia, Charlottesville VA; 5Department of Endocrinology, University of Virginia, Charlottesville VA Background: Insurance companies have considerable pre-bariatric surgery requirements despite lack of evidence in improved outcomes. Previous studies have analyzed mandated diet programs' impact on surgical delay, surgical drop-out and weight loss preand post-operatively; however, this is the first study to look at the association between multiple insurance requirements and failure to undergo surgery. We hypothesize company specific requirements are independently predictive of progression to surgery and time to surgery from initial consultation.