Effects of bariatric surgery in older patients

OBJECTIVE: Evaluate the safety and efficacy of bariatric surgery in older patients. BACKGROUND: Because of an increased morbidity in older patients who may not be as active as younger individuals, there remain concerns that they may not tolerate the operation well or lose adequate amounts of weight. METHODS: The database of patients who had undergone bariatric surgery since 1980 and National Death Index were queried for patients <60 and >/= 60 years of age. GBP was the procedure of choice after 1985. Data evaluated at 1 and 5 years included weight lost, % weight lost (%WL), % excess weight loss (%EWL), % ideal body weight (%IBW), mortality, complications, and obesity comorbidity. RESULTS: Eighty patients underwent bariatric surgery: age 63 +/- 3 years, 78% women, 68 white, 132 +/- 22 kg, BMI 49 +/- 7 kg/m, 217 +/- 32%IBW. Preoperative comorbidity, was greater (P < 0.001) in patients >/= 60 years. There were no operative deaths but 11 late deaths. Complications: 4 major wound infections, 2 anastomotic leaks, 10 symptomatic marginal ulcers, 5 stomal stenoses, 3 bowel obstructions, 26 incisional hernias (nonlaparoscopic), and 1 pulmonary embolism. At 1 year after surgery (94% follow-up), patients lost 38 +/- 11 kg, 57%EWL, 30%WL, BMI 34.5 +/- 7 kg/m, %IBW 153 +/- 31. Comorbidities decreased (P < 0.001); however, %WL and %EWL and improvement in hypertension and orthopedic problems, although significant, were greater in younger patients. At 5 years after surgery (58% follow-up), they had lost 31 +/- 18 kg, 50%EWL, 26%WL, BMI 35 +/- 8 kg/m, and %IBW 156 +/- 36. CONCLUSIONS: Bariatric surgery was effective for older patients with a low morbidity and mortality. Older patients had more pre- and post-operative comorbidities and lost less weight than younger patients. However the weight loss and improvement in comorbidities in older patients were clinically significant.