Biliopancreatic diversion with duodenal switch is safe regardless of age in appropriately selected patients: an MBSAQIP analysis.

backgroundThe rates of severe obesity, the proportion of the population aged 65 and older, and the utilization of biliopancreatic diversion with duodenal switch (BPD-DS) are increasing. In this context, we seek to define the safety profile of BPD-DS as patients age.

methodsWe queried the MBSAQIP database from 2020 to 2024 to identify individuals undergoing primary BPD-DS. Patients were divided into three cohorts by age (< 50 years, 50-64 years, ≥ 65 years). Baseline demographics and 30-day outcomes were compared using Fisher exact and Wilcoxon rank sum tests where appropriate. A 1:1 propensity match was created to compare the younger two cohorts. These cohorts were compared to the oldest with 1:4 propensity matches. Multivariable logistic regression modeling was used to assess predictors of complications.

results10,305 patients were identified. 7470 (72.5%) were < 50, 2488 (24.1%) were 50-64, and 347 (3.1%) were ≥ 65 years. Complication rates were higher in the older cohorts (6.9% vs 9.4% vs 10.4% (p < 0.001)). Rates of anastomotic leak, organ space infection, reoperation, and readmission all increased across age groups (all p < 0.028). After propensity matching, there were no differences in complication rates between patients ≥ 65 and the younger cohorts. On direct comparison of the younger cohorts, patients aged 50-64 experienced higher rates of reoperation (2.6% vs 1.6%, p = 0.025), readmission (5.8% vs 4.2%, p = 0.015), minor complication (6.7% vs 5.1%, p = 0.030), major complication (5.5% vs 3.2%, p < 0.001), and any complication (9.0% vs 6.9%, p = 0.008).

conclusionThe risk for postoperative complications following BPD-DS increases with age. When controlling for baseline associated conditions, patients 65 and older have outcomes equivalent to younger adults. In appropriately selected patients, BPD-DS is safe regardless of patient age.