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      Revisional bariatric procedures in the group of patients over 60 years of age: a multicenter cohort study (PROSS Study)

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          Abstract

          Introduction

          The constantly increasing prevalence of obesity in the population and the lengthening of life expectancy affect the appearance of the problem of pathological obesity also in the elderly. At the same time, an increase in the number of bariatric procedures (also revisional) performed in elderly patients is observed.

          Aim

          To assess the indications for revisional bariatric procedures along with the safety and postoperative results in the group of patients over 60 years of age.

          Material and methods

          The study was conducted in 2019–2020 among patients undergoing revisional bariatric procedures in Polish bariatric centers. The data were obtained through a multicenter, observational retrospective study.

          Results

          Our data consist of 55 (8.1%) patients older than 60 years of age who underwent revisional bariatric procedures. Revisional procedures in the group of patients over 60 years of age had fewer postoperative complications (16.4% vs. 23.1%, p < 0.05). Remission of type II diabetes or arterial hypertension was achieved to a lesser extent in patients operated on over the age of 60 (13% and 15%, respectively) compared to patients operated on under the age of 60 (47% and 34%, respectively; p < 0.05).

          Conclusions

          Revisional bariatric procedures in the group of patients over 60 years of age do not cause an increased risk of postoperative complications or prolonged hospital stay. The possibility of achieving remission or improvement in the treatment of comorbidities in patients operated on over 60 years of age is relatively lower compared to a younger group.

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          Most cited references40

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          Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.

          Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers and therapies and over time. A classification of complications published by one of the authors in 1992 was critically re-evaluated and modified to increase its accuracy and its acceptability in the surgical community. Modifications mainly focused on the manner of reporting life-threatening and permanently disabling complications. The new grading system still mostly relies on the therapy used to treat the complication. The classification was tested in a cohort of 6336 patients who underwent elective general surgery at our institution. The reproducibility and personal judgment of the classification were evaluated through an international survey with 2 questionnaires sent to 10 surgical centers worldwide. The new ranking system significantly correlated with complexity of surgery (P < 0.0001) as well as with the length of the hospital stay (P < 0.0001). A total of 144 surgeons from 10 different centers around the world and at different levels of training returned the survey. Ninety percent of the case presentations were correctly graded. The classification was considered to be simple (92% of the respondents), reproducible (91%), logical (92%), useful (90%), and comprehensive (89%). The answers of both questionnaires were not dependent on the origin of the reply and the level of training of the surgeons. The new complication classification appears reliable and may represent a compelling tool for quality assessment in surgery in all parts of the world.
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            Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

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              Frailty syndrome: an overview

              Frailty is a common and important geriatric syndrome characterized by age-associated declines in physiologic reserve and function across multiorgan systems, leading to increased vulnerability for adverse health outcomes. Two major frailty models have been described in the literature. The frailty phenotype defines frailty as a distinct clinical syndrome meeting three or more of five phenotypic criteria: weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss. The frailty index defines frailty as cumulative deficits identified in a comprehensive geriatric assessment. Significant progress has recently been made in understanding the pathogenesis of frailty. Chronic inflammation is likely a key pathophysiologic process that contributes to the frailty syndrome directly and indirectly through other intermediate physiologic systems, such as the musculoskeletal, endocrine, and hematologic systems. The complex multifactorial etiologies of frailty also include obesity and specific diseases. Major clinical applications include risk assessment and stratification. This can be applied to the elderly population in the community and in a variety of care settings. Frailty may also be useful for risk assessment in surgical patients and those with cardiovascular diseases, cancer, or human immunodeficiency virus infection, as well as for assessment of vaccine effectiveness in older adults. Currently, exercise and comprehensive geriatric interdisciplinary assessment and treatment are key interventions for frailty. As understanding of the biologic basis and complexity of frailty further improves, more effective and targeted interventional strategies and innovative geriatric-care models will likely be developed.
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                Author and article information

                Journal
                Wideochir Inne Tech Maloinwazyjne
                Wideochir Inne Tech Maloinwazyjne
                WIITM
                Videosurgery and other Miniinvasive Techniques
                Termedia Publishing House
                1895-4588
                2299-0054
                15 December 2023
                December 2023
                : 18
                : 4
                : 671-679
                Affiliations
                [1 ]Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
                [2 ]2 nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
                [3 ]Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
                Author notes
                Address for correspondence Piotr Zarzycki, Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland. e-mail: piotr.zarzycki23@ 123456gmail.com
                Article
                52091
                10.5114/wiitm.2023.133843
                10793152
                38239577
                cad9c664-d34a-4318-bef5-9e7c0b0532b5
                Copyright: © 2023 Fundacja Videochirurgii

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                : 07 October 2023
                : 10 December 2023
                Categories
                Original Paper

                obesity,elderly,bariatric,revisional surgery
                obesity, elderly, bariatric, revisional surgery

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