Luke Perry, DO, Kevin Engledow, DO, Gus Slotman, MD. Inspira Medical Center Vineland New Jersey
Introduction: In today’s overweight society, every surgeon must operate on medically high-risk morbidly obese patients. In this milieu of toxic obesity, every clinical insight helps. Although we have reported increased obesity co-morbidities in Medicare patients, some of whom are younger on disability, the specific risks of weight-related peri-operative problems by age are unknown. Objective: To identify the incidence of obesity co-morbidities by decades of age in pre-operative bariatric surgery patients.
Methods: Pre-operative data on 166,601 patients from the Surgical Review Corporation’s BOLD database was analyzed by age: <30 (n=18,119), 30-40 (n=41,879), 40-50 (n=46,911), 50-60 (n=40,788), 60-70 (n=17,475, >70 (n=1,429) years. Data included demographics, BMI, and % incidence of 33 obesity co-morbid conditions. Statistics: ANOVA for continuous variables; Dichotomous variables by general linear models modified for binomial distribution.
Results: BMI varied inversely by age (48+-8 <30 to 44+-8 >70), as did female/male percent (84/16 <30 to 64/36 >70) (p<0.0001). African-American/Caucasian/Hispanic race percent varied from 12.4/67.5/12.6 in the <30 group to 7.0/86.6/2.2 among patients >70 years of age (p<0.0001). Variations by age of obesity co-morbidities are displayed in the Table. The incidence of hernia, abdominal panniculitis, angina, cholelithiasis, CHF, DVT/PE, fibromyalgia, impaired function, GERD, diabetes, gout, hypertension, ischemic heart disease, dyslipidemia, leg edema, back pain, musculoskeletal pain, obesity hypoventilation, PVD, pulmonary hypertension, stress incontinence, and unemployment increased directly with increasing age, peaking in the >70 group (12) and the 60-70 years cohort (10) (p<0.0001). Asthma, depression, psychological impairment, and liver disease were highest in the 40-60 decades, but lower <30 and >70 (p<0.0001). Alcohol/tobacco/substance use, PCOS, mental health diagnosis, and pseudotumor cerebri (n-6) were inversely proportional to increasing age <30 to 60-70, >70 (p<0.0001).
Conclusion: Among adult surgical patients with obesity, the incidences of weight-related medical conditions vary by age. Younger patients are heavier, more frequently female, African-American or Hispanic, and have more psychological/behavioral issues. The major cardiopulmonary, abdominal/hepatobiliary, endocrine/metabolic, and weight-induced somatic issues increase in prevalence directly with increasing age. This severe age variation in morbid obesity suggests exaggerated adverse effects the longer one has obesity. Although BOLD did not capture the length of time each patient was morbidly obese, these result suggest the concept of obesity years, with entrenched co-morbidities accumulating the longer patients carry excess weight. These results may not be perfectly representative of all obese surgical patients. Nevertheless, applying this advance knowledge clinically may facilitate presumptive management of obese surgical patients, reduced peri-operative adverse events, and improving outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93821
Program Number: P156
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster