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Background <p>A subset of older adults who undergo metabolic and bariatric surgery (MBS) eventually requires revision or conversion of their index MBS procedure. However, the relative safety of revision/conversion MBS in the older population as compared to younger adults is unclear.</p> Methods <p>We conducted a retrospective comparative analysis of postoperative outcomes of revision/conversion MBS in patients 18–65&#xa0;years of age (Younger) versus &gt; 65&#xa0;years of age (Older) using the 2020–2024 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Our primary outcome was 30-day incidence of major complications, defined as Clavien–Dindo Grade ≥ 2.</p> Results <p>From a total of 118,208 revision/conversion MBS procedures, 8042 (6.8%) were in the Older age group. Older patients had a lower BMI, were more likely to be male, and had a greater incidence of comorbid medical conditions at baseline compared to younger patients. After adjusting for patient and procedure-level covariates, older patients had a significantly greater odds of major complications (adjusted OR 1.21 [95% CI 1.11–1.32], <i>p</i> &lt; 0.0001), anastomotic or staple line leak (adjusted OR 1.68 [95% CI 1.31–2.13], <i>p</i> &lt; 0.0001), and reoperation (adjusted OR 1.17 [95% CI 1.02–1.33], <i>p</i> = 0.026). Older patients also had a longer average operative time (Mean Difference (MD) 12.05&#xa0;min [95% CI 10.48–13.62], <i>p</i> &lt; 0.0001), length of hospital stay (MD 0.32&#xa0;days [95% CI 0.27–0.37], <i>p</i> &lt; 0.0001), and a lower change in BMI at 30&#xa0;days (MD 0.1&#xa0;kg/m<sup>2</sup> lower change in BMI [95% CI 0.04–0.15], <i>p</i> = 0.0003). There were no differences between the two age groups in odds of re-intervention or readmission at 30&#xa0;days. </p> Conclusion <p>Based on MBSAQIP data, revision/conversion MBS is associated with a significantly greater risk of morbidity in older patients as compared to younger adults. These findings suggest that revision/conversion MBS should be offered in the &gt; 65 age group with careful consideration of patient factors and closer perioperative monitoring to optimize postoperative outcomes.</p> Graphical abstract <p></p>

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Short-term safety and efficacy of revision or conversion metabolic and bariatric surgery in older adults: an analysis of the MBSAQIP database

  • 期刊论文

  • 发表日期：

    2026年7月10日

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  • Karanbir Brar,
  • Keri A. Seymour,
  • Ranjan Sudan,
  • Shaina R. Eckhouse,
  • Jacob A. Greenberg,
  • James J. Jung

摘要

Background

A subset of older adults who undergo metabolic and bariatric surgery (MBS) eventually requires revision or conversion of their index MBS procedure. However, the relative safety of revision/conversion MBS in the older population as compared to younger adults is unclear.

Methods

We conducted a retrospective comparative analysis of postoperative outcomes of revision/conversion MBS in patients 18–65 years of age (Younger) versus > 65 years of age (Older) using the 2020–2024 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Our primary outcome was 30-day incidence of major complications, defined as Clavien–Dindo Grade ≥ 2.

Results

From a total of 118,208 revision/conversion MBS procedures, 8042 (6.8%) were in the Older age group. Older patients had a lower BMI, were more likely to be male, and had a greater incidence of comorbid medical conditions at baseline compared to younger patients. After adjusting for patient and procedure-level covariates, older patients had a significantly greater odds of major complications (adjusted OR 1.21 [95% CI 1.11–1.32], p < 0.0001), anastomotic or staple line leak (adjusted OR 1.68 [95% CI 1.31–2.13], p < 0.0001), and reoperation (adjusted OR 1.17 [95% CI 1.02–1.33], p = 0.026). Older patients also had a longer average operative time (Mean Difference (MD) 12.05 min [95% CI 10.48–13.62], p < 0.0001), length of hospital stay (MD 0.32 days [95% CI 0.27–0.37], p < 0.0001), and a lower change in BMI at 30 days (MD 0.1 kg/m2 lower change in BMI [95% CI 0.04–0.15], p = 0.0003). There were no differences between the two age groups in odds of re-intervention or readmission at 30 days.

Conclusion

Based on MBSAQIP data, revision/conversion MBS is associated with a significantly greater risk of morbidity in older patients as compared to younger adults. These findings suggest that revision/conversion MBS should be offered in the > 65 age group with careful consideration of patient factors and closer perioperative monitoring to optimize postoperative outcomes.

Graphical abstract