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June 1, 2007

Avoidance of Complications in Older Patients and Medicare Recipients Undergoing Gastric Bypass

Author Affiliations

Author Affiliations: Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Arch Surg. 2007;142(6):506-512. doi:10.1001/archsurg.142.6.506

Hypothesis  Perioperative morbidity and mortality do not increase in carefully evaluated and managed Medicare and elderly patients undergoing gastric bypass.

Design  Retrospective review of a prospectively maintained bariatric database.

Setting  Academic tertiary care medical center.

Patients  We reviewed our database of 928 consecutive patients who underwent gastric bypass from March 24, 1998, through May 31, 2006. Of these patients, 36 underwent revision surgery and were excluded. The remaining 892 patients were separated into 4 groups by age and Medicare status. Group 1 consisted of 46 patients 60 years or older at the time of gastric bypass (range, 60-66 years). Group 2 consisted of 846 patients 59 years or younger at the time of gastric bypass (range, 18-59 years). Group 3 consisted of 31 Medicare recipients (age range, 31-66 years). Group 4 consisted of 861 non-Medicare recipients (age range, 18-64 years).

Main Outcome Measures  Groups were compared in terms of demographics, morbidity, and mortality.

Results  No differences were found in outcomes between older vs younger and Medicare vs non-Medicare patients for any postoperative complication or mortality.

Conclusions  Bariatric surgery can be performed in carefully selected Medicare recipients and patients 60 years or older with acceptable morbidity and mortality. No difference was found in the occurrence of complications in Medicare patients, patients younger than 60 years, or patients 60 years and older. We believe that these results reflect careful patient selection, intensive preoperative education, and expert operative and perioperative management. Our results indicate that bariatric surgery should not be denied solely based on age or Medicare status.