Background

Bariatric surgery is increasingly common among elderly patients, yet conversion trends remain under-explored in this population. Utilizing the MBSAQIP database, this study aims to provide a comprehensive analysis of conversion trends post-bariatric surgery in the elderly.

Methods

We conducted a retrospective analysis of conversional bariatric surgeries reported in the MBSAQIP database from 2020 and 2022. The percentage of cases, demographics, indications, complications, and mortality for conversional procedures in elderly patients were analyzed.

Results

Out of 51,138 conversional bariatric surgery patients, 3,746 elder patients underwent conversions during 2020-2022. The initial procedures included 1,479 (39,4%) sleeve gastrectomy (SG), 2,086 (55.6%) adjustable gastric banding (AGB) and 181 (4.8%) vertical banded gastroplasty (VBG), respectively. Baseline comorbidities were similar between groups. The indications for surgery varied based on the conversional procedures, however conversional cases focused more on weight-related complications. In the elderly, SG-to-Roux en-Y gastric bypass (RYGB) was the most common conversion (1359, 91.9%), followed by AGB-to-SG (1203, 57.6%), and AGB-to-RYGB (830, 39.7 %). VBG conversions occurred to SG (13, 7.2%) or RYGB (168, 92.8%). VBG to-RYGB had the longest operative time (249 +- 110.9 minutes) and length of stay (3.7. +- 5.8 days). VBG-to-RYGB had the highest serious complication (31, 18.4%), reoperation (13, 7.7%), postoperative bleeding (4, 4.1%) and mortality (7, 4.1%) rates. (Table 1).

Conclusions

Our results suggest different patterns for conversional bariatric surgery in the elderly. This study shows that procedures were safe, although complications rates and mortality were higher after VBG-to-RYGB conversions.