Bariatric Surgery Is Effective and Safe in Patients Over 55: a Systematic Review and Meta-analysis
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Effective weight loss and reduction in comorbidities has been convincingly demonstrated with bariatric surgery. Concerns regarding increased perioperative complications and poor results have led to a reluctance to offer such surgery to older patients. We performed a systematic review and meta-analysis of the published evidence for those in the ≥55-year age group. An electronic search was conducted of MEDLINE, EMBASE, and the Cochrane Library databases from 1990 to December 2010. We included laparoscopic studies published in English where the results were broken down by surgical procedure, reporting a minimum 6-month follow-up for ≥10 patients aged ≥55. After an initial screen of 2,543 titles, 298 abstracts were reviewed. Eighteen studies were included in the analysis. Of these, 10 included patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) (663 patients), and 11 included patients undergoing laparoscopic adjustable gastric banding (LAGB) (543 patients). Meta-analyses of body mass index (BMI) reductions indicated sustained and clinically significant BMI reductions for both RYGB (mean percentage of excess weight loss at 1 year, 72.6 %) and LAGB (mean percentage of excess weight loss at 1 year, 39.1 %). The 30-day mortality was 0.30 and 0.18 % for LRYGB and LAGB, respectively. Meta-analysis of old versus young patients revealed better comorbidity and mortality outcomes for younger patients. Bariatric surgery for patients ≥55 years achieves weight loss and reduction in comorbidities and mortality comparable to the general bariatric surgery population. Based on the above findings, patients should not be denied bariatric surgery on the basis of age alone.
- Hirani V, Zaninotto P, Primatesta P. Generalised and abdominal obesity and risk of diabetes, hypertension and hypertension-diabetes co-morbidity in England. Public Health Nutr. 2008;11(5):521–7. CrossRef
- Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37. CrossRef
- Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54. CrossRef
- Dh. Health profile of England 2009. Health San Francisco. 2010;2011(24th March):120.
- Burns EM, Naseem H, Bottle A, et al. Introduction of laparoscopic bariatric surgery in England: observational population cohort study. Br Med J. 2010;341:c4296. CrossRef
- RevMan. Review manager (RevMan) [computer program]. Version 5.1. Copenhagen: the Nordic Cochrane Centre, The Cochrane Collaboration. 2008.
- O’Keefe KL, Kemmeter PR, Kemmeter KD. Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery Center of Excellence. Obes Surg. 2010;20(9):1199–205. CrossRef
- Quebbemann B, Engstrom D, Siegfried T, et al. Bariatric surgery in patients older than 65 years is safe and effective. Surg Obes Relat Dis Off J Am Soc Bariatric Surg. 2005;1(4):389–92. discussion 392–3.
- St Peter SD, Craft RO, Tiede JL, et al. Impact of advanced age on weight loss and health benefits after laparoscopic gastric bypass. Arch Surg (Chicago, Ill/: 1960). 2005;140(2):165–8. CrossRef
- Taylor CJ, Layani L. Laparoscopic adjustable gastric banding in patients > or =60 years old: is it worthwhile? Obes Surg. 2006;16(12):1579–83. CrossRef
- Willkomm CM, Fisher TL, Barnes GS, et al. Surgical weight loss >65 years old: is it worth the risk? Surg Obes Relat Dis. 2010;6(5):491–6. CrossRef
- Dixon JB, McPhail T, O’Brien PE. Minimal reporting requirements for weight loss: current methods not ideal. Obes Surg. 2005;15(7):1034–9. CrossRef
- Printen KJ, Mason EE. Gastric bypass for morbid obesity in patients more than fifty years of age. Surg Gynecol Obstet. 1977;144(2):192–4.
- Livingston EH, Huerta S, Arthur D, et al. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;236(5):576–82. CrossRef
- Flum DR, Salem L, Elrod JAB, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA J Am Med Assoc. 2005;294(15):1903–8. CrossRef
- Busetto L, Angrisani L, Basso N, et al. Safety and efficacy of laparoscopic adjustable gastric banding in the elderly. Obesity (Silver Spring). 2008;16(2):334–8. CrossRef
- Abu-Abeid S, Keidar A, Szold A. Resolution of chronic medical conditions after laparoscopic adjustable silicone gastric banding for the treatment of morbid obesity in the elderly. Surg Endosc. 2001;15(2):132–4. CrossRef
- Clough A, Layani L, Shah A, et al. Laparoscopic gastric banding in over 60s. Obes Surg. 2011;21(1):10–7. CrossRef
- Fazylov R, Soto E, Merola S. Laparoscopic Roux-en-Y gastric bypass in morbidly obese patients > or =55 years old. Obes Surg. 2008;18(6):656–9. CrossRef
- Frutos MD, Luján J, Hernández Q, et al. Results of laparoscopic gastric bypass in patients > or =55 years old. Obes Surg. 2006;16(4):461–4. CrossRef
- Hazzan D, Chin EH, Steinhagen E, et al. Laparoscopic bariatric surgery can be safe for treatment of morbid obesity in patients older than 60 years. Surg Obes Relat Dis Off J Am Soc Bariatric Surg. 2006;2(6):613–6.
- Mittermair RP, Aigner F, Obermüller S. Results and complications after Swedish adjustable gastric banding in older patients. Obes Surg. 2008;18(12):1558–62. CrossRef
- Papasavas PK, Gagné DJ, Kelly J, et al. Laparoscopic Roux-En-Y gastric bypass is a safe and effective operation for the treatment of morbid obesity in patients older than 55 years. Obes Surg. 2004;14(8):1056–61. CrossRef
- Silecchia G, Greco F, Bacci V, et al. Results after laparoscopic adjustable gastric banding in patients over 55 years of age. Obes Surg. 2005;15(3):351–6. CrossRef
- Sosa JL, Pombo H, Pallavicini H, et al. Laparoscopic gastric bypass beyond age 60. Obes Surg. 2004;14(10):1398–401. CrossRef
- Trieu HT, Gonzalvo JP, Szomstein S, et al. Safety and outcomes of laparoscopic gastric bypass surgery in patients 60 years of age and older. Surg Obes Relat Dis Off J Am Soc Bariatric Surg. 2007;3(3):383–6.
- Wittgrove AC, Martinez T. Laparoscopic gastric bypass in patients 60 years and older: early postoperative morbidity and resolution of comorbidities. Obes Surg. 2009;19(11):1472–6. CrossRef
- Wool D, Bellatorre N, Wren S, et al. Male patients above age 60 have as good outcomes as male patients 50–59 years old at 1-year follow-up after bariatric surgery. Obes Surg. 2009;19(1):18–21. CrossRef
- Bariatric Surgery Is Effective and Safe in Patients Over 55: a Systematic Review and Meta-analysis
Volume 22, Issue 9 , pp 1507-1516
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