Perioperative and 1-year outcomes of bariatric surgery in septuagenarians: implications for patient selection |
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| Institution: | 1. Department of General Surgery, University of Michigan, Ann Arbor, Michigan;2. Department of Surgery, Beaumont Hospital Dearborn, Dearborn, Michigan;3. Department of Surgery, Henry Ford Health System, Detroit, Michigan;1. King’s College London, London, U.K.;2. Harvard Medical School, Boston, MA;3. University of Colorado Anschutz Medical Campus, Aurora, CO;4. Cleveland Clinic, Cleveland, OH;5. Imperial College London, London, U.K.;6. Monash University, Melbourne, Victoria, Australia;7. University of Pisa, Pisa, Italy;8. Peking University, Beijing, China;9. Diabetes India, Mumbai, India;10. University of Michigan, Ann Arbor, MI;11. Philadelphia, PA;12. University of Washington, Seattle, WA;1. Defiance County Health Department, Defiance, Ohio;2. Division of Pediatric Surgery, Children’s Hospital of Colorado and University of Colorado, Anschutz Medical Campus, Aurora, Colorado;3. Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;1. Department of Surgery, Medical University of Vienna, Vienna, Austria;2. Department of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria;3. Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria;1. Department of Gastrosurgical Research, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden;2. Department of Paediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden;3. Department of Health and Care Sciences, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden;4. Department of Paediatric Surgery, Queen Silvia Children''s Hospital, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden;5. Department of Research, Royal College of Surgeons of England, London, UK;6. Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden;7. Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden;8. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden;9. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden;10. Department of Psychology, Lund University, Lund, Sweden;11. National Institute for Health and Welfare, Helsinki, Finland |
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| Abstract: | BackgroundAlthough bariatric surgery is an effective treatment for obesity, utilization of bariatric procedures in older adults remains low. Previous work reported higher morbidity in older patients undergoing bariatric surgery. However, the generalizability of these data to contemporary septuagenarians is unclear.ObjectivesWe sought to evaluate differences in 30-day outcomes, 1-year weight loss, and co-morbidity remission after bariatric surgery among 3 age groups as follows: <45 years, 45–69 years, and ≥70 years.SettingStatewide quality improvement collaborative.MethodsUsing a large quality improvement collaborative, we identified patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 2006 and 2018. We used multivariable logistic regression models to evaluate the association between age cohorts and 30-day outcomes, 1-year weight loss, and co-morbidity remission.ResultsWe identified 641 septuagenarians who underwent SG (68.5%) or RYGB (31.5%). Compared with 45–69 year olds, septuagenarians had higher rates of hemorrhage (5.1% versus 3.1%; P = .045) after RYGB and higher rates of leak/perforation (.9% versus .3%; P = .044) after SG. Compared with younger patients, septuagenarians lost less of their excess weight, losing 64.8% after RYGB and 53.8% after SG. Remission rates for diabetes and obstructive sleep were similar for patients aged ≥70 years and 45–69 years.ConclusionsBariatric surgery in septuagenarians results in substantial weight loss and co-morbidity remission with an acceptable safety profile. Surgeons with self-imposed age limits should consider broadening their selection criteria to include patients ≥70 years old. |
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| Keywords: | Bariatric surgery Health policy Outcomes Elderly Older adult Sleeve gastrectomy Roux-en-Y gastric bypass |
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