Does Age Influence Bariatric Surgery Outcomes?

Abstract

Aim: The purpose of this study was to evaluate presurgical comorbidities, perioperative and postoperative complications, and postsurgical outcomes of minimally invasive bariatric surgery in patients aged 55 years and older to determine if age should be used as a selection criteria for bariatric surgery. Methods: A total of 750 patients underwent sleeve gastrectomy or robotic-assisted Roux-en-Y gastric bypass from January 2008 to June 2014. Patients were divided into three groups according to age: <55 years old; ‡55 to <65 years old; and ‡65 years old. Demographics, presurgical comorbidities, perioperative and postoperative complications (leaks or conversions to open surgery), and postsurgical outcomes were compared across the different groups. Results: Significant differences in presurgical comorbidities were found across age groups ( p < 0.001). Results from descriptive statistics revealed that patients younger than 55 years of age had a greater number of complications-defined as leaks (n = 1) or conversions to open surgery (n = 2)-than did patients older than 55 years of age. There were no significant differences across age groups regarding length of stay. Linear regression analysis failed to reveal significant associations between age and percentage excess weight loss at 6, 12, and 24 months follow-up. Conclusions: These initial results suggest that patient selection for bariatric surgery should not be based on age alone.

Diabetic and Elder Patients Experience Superior Cardiovascular Benefits After Gastric Bypass Induced Weight Loss

“…Nonetheless, as the amount of clinical evidence enlarged, it became recognizable that the surgical outcomes of bariatric surgery, including morbidity and mortality rates, in older patients were not significantly different than those observed in younger ones ( 28 – 31 ). Thus, the number of bariatric procedures performed in older patients has increased over the past decades ( 32 , 33 ). Our data not only reinforces that weight loss achieved after RYGB in patients over 50 years old are not inferior to the observed in younger patients, but also suggests that the CV benefits in this patient group as compared to the younger ones are also more likely to be superior.…”

Treatment of obesity in older persons—A systematic review

“…Of 38 studies comparing the safety of bariatric procedures in older vs younger groups, 16 found no difference in early mortality or complication rates between groups . A further four studies found no difference between groups in overall complications, but higher rates of certain events in older participants, such as cardiac complications, intubation for longer than 48 hours, acute kidney injury, sepsis and pulmonary embolus, and bleeding .…”

“…Of the 28 studies in which weight outcomes for older and younger persons were compared, 16 found no significant difference in weight loss between groups, and seven studies reported less weight loss in older than younger participants . Greater total weight loss in younger participants but no difference in percent excess weight loss (%EWL) between groups was reported in two studies .…”

“…Ten studies evaluated only the safety of bariatric surgery, and the remainder evaluated weight loss efficacy as well as safety, although the reported measures of efficacy and safety varied between studies. Thirty‐nine of the 66 included studies compared outcomes between older adults and a younger group, and in 12 of these studies, groups were matched for characteristics such as sex, BMI, and surgery type. The remaining studies reported results for older persons without a comparison group.…”

“…Studies in which percentage total weight loss (%TWL) was reported in older people found loss of 17% to 38% after 1 to 6 years following gastric bypass and sleeve gastrectomy, and loss of 14% to 20% after adjustable gastric banding . For studies in which weight outcome was reported as percentage excess weight loss (%EWL), older persons undergoing RYGB or LSG lost 46% to 77% excess weight at 12 to 21 months, and 43% to 72% 2 to 6 years post‐operatively . After LAGB, studies reported %EWL of 14% to 36% at 1 year, and 35% to 48% at 5 years' follow‐up .…”