Incidence and outcomes after bariatric surgery in older patients: a state‐wide data‐linked cohort study

Morgan, David; Ho, Kwok M.

doi:10.1111/ans.13396

Cited by 8 publications

(6 citation statements)

References 20 publications

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“…The first published reports showed worse results of BS in older population (over 60-65 years old) compared with younger subjects, with lower weight loss outcomes and resolution of comorbidities, higher rate of complications, and post-operative mortality [23][24][25][26]. Nevertheless, more recent studies reported a tendency to better surgical outcomes in the elderly, probably due to better selection of patients and improvement of surgical techniques [27,28].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Endoscopic Sleeve Gastroplasty in the Elder Population

et al. 2022

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Purpose With the aging of the population and the epidemic spread of obesity, the frequency of older individuals with obesity is steadily growing. To date, no data evaluating the use of endoscopic sleeve gastroplasty (ESG) in the elderly have been published. In this case series, we evaluate the short- and medium-term outcomes of ESG in patients with obesity aged 65 years and older. Materials and Methods A retrospective analysis was done on a prospective database; patients aged 65 years and older were included in our analysis. EWL%, TBWL%, the Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire, and the presence of comorbidities were assessed. Results Eighteen patients aged 65 years and older underwent ESG between November 2017 and July 2021. The median age was 67 years and the mean baseline BMI was 41.2 kg/m2. After ESG, the median TBWL% was 15.1%, 15.5%, and 15.5% at 6, 12, and 24 months, while the median %EWL was 39%, 37%, and 41% at 6, 12, and 24 months, respectively. The median BAROS score was 3.0, 3.4, and 2.5 at 6, 12, and 24 months, respectively. Six out of twelve patients with hypertension and 3/4 diabetic patients reduced or removed their medications within 12 months following ESG. Two out of six patients with OSA stopped therapy with CPAP. No adverse events were recorded. Conclusion According to our experience, ESG is a promising therapeutic option for elder individuals with obesity who fail non-invasive methods, and who refuse or are deemed not suitable for bariatric surgery because of age and comorbidities. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Outcomes of Endoscopic Sleeve Gastroplasty in the Elder Population

et al. 2022

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“…RYGB appears to be particularly effective at inducing weight loss in older adults compared to SG [36*]; however, older individuals undergoing RYGB have been noted to have an increased risk of nearly all perioperative complications associated with laparoscopic bariatric surgery and longer hospital stays [37]. Despite these findings, older bariatric patients still have a reduced rate of hospitalization following surgery and no difference in 30-day morality rates [38*].…”

Section: Bariatric Surgerymentioning

confidence: 99%

Therapeutic and lifestyle approaches to obesity in older persons

Jiang

Villareal

2019

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of Review: Obesity rates worldwide continue to increase and will disproportionately affect older adults due to population aging. This review highlights recent progress pertaining to therapeutic approaches to obesity in older adults. Recent Findings: Caloric restriction (CR) alone improves physical function and quality of life in older adults with obesity but is associated with loss of lean mass and increases fracture risk. Adding progressive resistance training (RT) to CR attenuates loss of muscle and bone mass and increasing protein intake enhances this effect. Adding aerobic endurance training (AT) to CR further improves cardiorespiratory fitness but adding both AT and RT to CR results in the greatest improvement in overall physical function while still preserving lean mass. Future promising therapeutic interventions include testosterone, myostatin inhibitors, and bariatric surgery, but there are few studies specific to obese older adults. Summary: The optimal approach towards obesity in older persons is lifestyle intervention incorporating CR and exercise consisting of AT and RT. Maintenance of adequate protein intake, calcium, and vitamin D is advisable. There is insufficient evidence specific to obese older adults to recommend testosterone or bariatric surgery at this time. Myostatin inhibitors may become a future treatment and clinical trials are ongoing.

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“…Dorman et al, 13 in a database analysis enrolling 48,378 individuals who underwent varied bariatric surgical techniques, observed that patients aged 65 years or older presented a non-statistically significant trend toward higher mortality and did not experience higher risk of major complications for either open or laparoscopic procedures; nonetheless, they were more likely to experience prolonged length of stay. Morgan and Ho, 14 in a retrospective cohort study enrolling 12,062 individuals who underwent bariatric surgery, observed that 18.1% of all the procedures were performed in patients ≥ 55 years old; older bariatric patients were statistically more likely to require longer hospital admissions, have more postoperative complications and require intensive care admissions compared to patients < 55 years old; however, 30-day (no deaths in the older cohort) and long-term mortality rates did not differ from those observed in younger individuals, suggesting that bariatric surgery may confer health benefits to carefully selected obese older patients who cannot achieve weight loss by other means. Batsis et al, 15 in a retrospective population-based study that analyzed 40 consecutive individuals aged 60 years or older who underwent bariatric surgery, observed a perioperative mortality of 2.5%, along with considerable weight loss, improvement in cardiovascular risk factors, and decrease in prevalence of metabolic syndrome, considering it to be an effective treatment in this population.…”

Section: Search Strategies Resultsmentioning

confidence: 99%