The Outcome of Bariatric Surgery in Patients Aged 75 years and Older
- 144 Downloads
Bariatric surgery has been shown to be safe and effective in patients aged 60–75 years; however, outcomes in patients aged 75 or older are undocumented.
Patients aged 75 years and older who underwent bariatric procedures in two academic centers between 2006 and 2015 were studied.
A total of 19 patients aged 75 years and above were identified. Eleven (58%) were male, the median age was 76 years old (range 75–81), and the median preoperative body mass index (BMI) was 41.4 kg/m2 (range 35.8–57.5). All of the bariatric procedures were primary procedures and performed laparoscopically: sleeve gastrectomy (SG) (n = 11, 58%), adjustable gastric band (AGB) (n = 4, 21%), Roux-en-Y gastric bypass (RYGB) (n = 2, 11%), banded gastric plication (n = 1, 5%), and gastric plication (n = 1, 5%). The median operative time was 120 min (range 75–240), and the median length of stay was 2 days (range 1–7). Three patients (16%) developed postoperative atrial fibrillation which completely resolved at discharge. At 1 year, the median percentage of total weight loss (%TWL) was 18.4% (range 7.4–22.0). The 1-year %TWL varied among the bariatric procedures performed: SG (21%), RYGB (22%), AGB (7%), and gastric plication (8%). There were no 30-day readmissions, reoperations, or mortalities.
Our experience suggests that bariatric surgery in selected patients aged 75 years and older would be safe and effective despite being higher risk. Age alone should not be the limiting factor for selecting patients for bariatric surgery.
KeywordsBariatric surgery 75 years Mortality Morbidity Sleeve gastrectomy Risk factor Elderly Age Complication Gastric bypass
Compliance with Ethical Standards
Conflict of Interest
Advisory Board: The Medicines Company, GI Dynamics, Neurotronic, Pacira
Consultant: Ethicon, The Medicines Company, Novo Nordisk
Research Support: Ethicon, National Institutes of Health, Medtronic, Pacira
Educational grants: Karl Storz, Medtronics and Ethicon
Advisory board: Ethicon
Otherwise, the rest of the authors have no conflict of interest and nothing to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
For this retrospective study, formal consent is not required.
- 1.S Census Bureau International Database (IDB). Population projections of the US by age, sex, race, Hispanic origin, population division. http://www.census.gov/ipc/www/idb/country.php. Accessed September 13, 2013
- 2.Flegal KM, Kit BK, Orpana H, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309(1):71–82. https://doi.org/10.1001/jama.2012.113905.
- 3.Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14.Google Scholar
- 4.Gebhart A, Young MT, Nguyen NT. Bariatric surgery in the elderly: 2009–2013. Surg Obes Relat Dis. 2015;11(2):393–8.Google Scholar
- 5.Varela JE, Wilson SE, Nguyen NT. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72(10):865–9.Google Scholar
- 6.Dorman RB, Abraham AA, Al-Refaie WB, et al. Bariatric surgery outcomes in the elderly: an ACS NSQIP study. J Gastrointest Surg. 2012;16(1):35–44. https://doi.org/10.1007/s11605-011-1749-6.
- 7.Eldar S, Heneghan HM, Brethauer S, et al. A focus on surgical preoperative evaluation of the bariatric patient—the Cleveland Clinic protocol and review of the literature. Surgeon. 2011;9(5):273–7.Google Scholar
- 8.Aminian A, Andalib A, Khorgami Z, et al. Who should get extended thromboprophylaxis after bariatric surgery?: a risk assessment tool to guide indications for post-discharge pharmacoprophylaxis. Ann Surg. 2017;265(1):143–50. https://doi.org/10.1097/SLA.0000000000001686.
- 9.Brethauer SA, Kim J, El Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489–506.Google Scholar
- 10.Aminian A, Brethauer SA, Andalib A, et al. Can sleeve gastrectomy “cure” diabetes? Long-term metabolic effects of sleeve gastrectomy in patients with type 2 diabetes. Ann Surg. 2016;64(4):674–81.Google Scholar
- 11.Brethauer SA, Aminian A, Romero-Talamas H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628–36.Google Scholar
- 12.Aminian A, Brethauer SA, Kirwan JP, et al. How safe is metabolic/diabetes surgery? Diabetes Obes Metab. 2015;17(2):198–201.Google Scholar
- 13.Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults.Cochrane Database Syst Rev 2014;8:CD003641.Google Scholar
- 14.Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.Google Scholar
- 15.Sugerman HJ, DeMaria EJ, Kellum JM, et al. Effects of bariatric surgery in older patients. Ann Surg. 2004 Aug 1;240(2):243–7.Google Scholar
- 16.Ramirez A, Roy M, Hidalgo JE, et al. Outcomes of bariatric surgery in patients >70 years old. Surg Obes Relat Dis. 2012;8(4):458–62.Google Scholar
- 17.Loy JJ, Youn HA, Schwack B, et al. Safety and efficacy of laparoscopic adjustable gastric banding in patients aged seventy and older. Surg Obes Relat Dis. 2014;10(2):284–9.Google Scholar
- 18.Giordano S, Victorzon M. Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging. 2015;10:1627–35.Google Scholar
- 19.Oreopoulos A, Kalantar-Zadeh K, Sharma AM, et al. The obesity paradox in the elderly: potential mechanisms and clinical implications. Clin Geriatr Med. 2009;25(4):643–59.Google Scholar
- 20.Cetin DC, Nasr GA. Obesity in the elderly: more complicated than you think. Cleve Clin J Med. 2014;81(1):51–61.Google Scholar
- 21.Aminian A, Daigle CR, Romero-Talamas H, et al. Risk prediction of complication of metabolic syndrome before and 6 years after gastric bypass. Surg Obes Relat Dis. 2014;10(4):576–82.Google Scholar
- 22.Aminian A, Zelisko A, Kirwan JP, et al. Exploring the impact of bariatric surgery on high density lipoprotein. Surg Obes Relat Dis. 2015;11(1):238–47.Google Scholar
- 23.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.Google Scholar
- 24.Schauer PR, Bhatt DL, Kirwan JP, et al. Metabolic surgery vs. intensive medical therapy for diabetes: 5-year outcomes. N Engl J Med. 2017;376(7):641–51.Google Scholar
- 25.Aminian A, Brethauer SA, Andalib A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg. 2017;266(4):650–7.Google Scholar