Tu1800 Effect of Bariatric Surgery on Comorbidities vs Medical Treatment in a Cohort of Morbidly Obese Patients: A Prospective Study

Abstract

As it is being common in Japan to perform surgery in patients over 85 years old, postoperative complications such as pneumonia, heart failure, dementia, and bedridden status become big problems for patients and their family. Although some prognostic scoring systems such as POSSUM score are available, these scoring systems do not precisely predict the postoperative complications. Aim of the present study was to evaluate mortality and morbidity after the surgery and consider surgical indication in super-old patients. Methods: We retrospectively reviewed 222 patients who underwent surgery from 2003 to 2010 at the age over 85 years and analyzed postoperative mortality and morbidity rate. In our hospital, indications of surgery in super-old patients were, 1) informed consent from patient and his/her family and 2) good pulmonary and cardiac function to tolerate operation. We evaluated POSSUM score for information, and poor POSSUM score was not considered as an absolute contraindication. Results: Among 222 operations, emergent operations were 114, while elective operations were 108. Diseases for operation were gastric cancer in 24, colorectal cancer in 49, cholecystolithiasis in 9, inguinal hernia in 19 patients. Emergent operations included perforation of GI tract for 26, acute cholecystitis for 22, intestinal obstruction for 21, inguinal hernia for 20, acute appendicitis for 10, and colorectal cancer for 7 patients. Mortality and morbidity rates in elective surgery were 1.9% (2 patients) and 31.5% (34 patients), respectively, while those in emergent operation increased to 14.9% (17 patients) and 58.4% (66 patients) (p<0.01 vs. elective operation), respectively. Pulmonary complications were observed in 5 (1.9%) and 24 (21.1%) patients in elective and emergent surgeries, respectively. In 19 patients with postoperative deaths, 15 (79.4%) suffered from pulmonary diseases including aspiration pneumonia. Mortality rate in patients with pulmonary complications increased to 51.7% in elective and emergent operations. In patients undergoing operations for upper GI tract, pulmonary complications were observed in 8.3% in elective operations and 42.9% (3/7) in emergent operations, and all 3 patients died of pulmonary complications. Conclusions: In super-old patients, mortality and morbidity rates in emergent operations were high compared to those in elective operations. These results indicate importance of preoperative estimation in super-old patients, and indication of the operation should be carefully considered in patients with poor pulmonary function.