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Surgery and elderly patients

Bariatric surgery after age 60 is safe and effective

Multivariate analysis revealed a significant negative association between the number of medications and overall survival

Bariatric surgery in patients age 60 and older is safe and effective, producing results comparable to those seen in younger adults, according to researchers from the Geisinger Medical Center in Danville, PA, who presented their findings at ObesityWeek 2017 - the largest international event focused on the basic science, clinical application and prevention and treatment of obesity hosted by the American Society for Metabolic and Bariatric Surgery and The Obesity Society.

“Our study shows that both laparoscopic gastric bypass and sleeve gastrectomy can be as safe and as beneficial for older adults as it is for younger patients,” said study co-author, Dr Anthony T Petrick, Director, Bariatrics and Minimally Invasive Surgery, Geisinger Health System.

The authors noted that obesity in the elderly compounds the disease burden leading to poor mobility and quality of life. Although bariatric surgery is the most effective treatment of obesity, there are only a few large studies evaluating perioperative and long term outcomes in elderly patients therefore they decided to undertake a retrospective analysis.

Of data from a prospectively maintained database of all patients who underwent bariatric surgery between January 2007 and April 2017. A total of 337 patients age 60 or greater who underwent a sleeve gastrectomy (32 patients), or open (115 patients) or laparoscopic Roux-en-Y gastric bypass (190 patients) between 2007 and 2017. The population was 75.4% female. Before surgery, patients had a BMI46.9, The mean preoperative medication count was 8.2 and 62.6 percent had Type 2 diabetes.

The outcomes revealed that the 90-day mortality rate was 0.3%, with a major and minor morbidity rate of 5.6% and 16%, respectively. The minor complication between LRYGB and LSG was similar however the major complication rate was significantly higher for the LRYGB (3.2% vs 0%; p=0.004), and the readmission rate was 8.3%.

During a median follow-up period of 56.2 months (CI 49.5-62.9), the mean percent excess weight loss (EWL) at nadir was 72.1%±24.7 (n=238) and EWL at 36 months or beyond was 60.9%±27.6 (n=205). On regression analysis, diabetes, BMI and LSG were negatively associated with EWL at all time periods (p<0.05).

The mean percent EWL was statistically greater for RYGB compared to LSG (61.7 versus 41.2; p=0.039) at or greater than 36 months. The diabetes remission rate was 45.8% with a median remission time of 3.8 years. There were 25 deaths within the ten-year study period. Multivariate analysis revealed a significant negative association between the number of medications and overall survival (HR 1.160, CI 1.068-1.260), but did not reveal any significant association with age, BMI, sex or comorbid conditions (myocardial infarction, heart failure, pulmonary disease, malignancy or diabetes).

“Our study supports that both the sleeve gastrectomy and gastric bypass surgery can be safely performed in elderly patients with effective long term control of obesity and obesity related comorbidities,” the authors concluded.

“With the graying of America, more seniors will continue to turn to bariatric surgery to treat their obesity and related diseases including Type 2 diabetes,” said ASMBS secretary/treasurer, Dr Eric DeMaria, Director of Bariatric Surgery, Bon Secours Maryview Medical Center in Portsmouth, Virginia, who was not involved in the study. “This study provides further evidence that they can do so with confidence.”

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