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Invited Critique
November 1, 2006

The Impact of Age and Medicare Status on Bariatric Surgical Outcomes—Invited Critique

Arch Surg. 2006;141(11):1121. doi:10.1001/archsurg.141.11.1121

In this article, Livingston and Langert examined outcomes from bariatric procedures using 2 databases, the National Inpatient Survey and the National Hospital Discharge Survey, and found that age, male sex, certain comorbidities, and Medicare status adversely affected short-term outcomes, such as perioperative complications and operative mortality, with these complications increasing steeply after the age of 65 years. When patients with similar comorbidities were compared, Medicare status alone did not affect outcomes. The study has some of the inherent shortcomings of retrospective data acquisition from large databases. For example, all bariatric procedures were analyzed together (Roux-en-Y gastric bypass, biliopancreatic diversion with duodenal switch, lap band, etc), so we have no idea if these data apply to all procedures. Furthermore, the data are collected from all hospitals, not simply from those that have bariatric centers. Conspicuously absent from the data is an analysis of the effect of weight and body mass index on outcomes; perhaps these data were not obtainable from these databases.