Determining the Best Bariatric Surgery for Older Patients
Obesity is increasingly prevalent among the 60 years and older population. The crude prevalence of grades II (severe) and III (morbid) obesity (BMI ≥ 35 and BMI ≥40 respectively) is estimated to be 14% in these age groups. Surgical treatment has been shown to be significantly more effective than nonsurgical therapy in reducing weight, resolving the metabolic syndrome, and improving quality of life in morbidly obese patients. Despite studies reporting that weight loss in older patients who undergo bariatric surgery is not as effective, present higher complication rates and increased mortality, elderly patients do undergo bariatric procedures routinely. The major concerns of bariatric surgery in the older population are safety and effectiveness.
Objectives: The objective of this study is to report our institutional experience in performing minimally invasive bariatric surgery in patients aged 60 years or older and to compare long-term weight loss outcomes (%EWL and BMI reduction) as well as complications for three procedures: Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG) and Laparoscopic Adjustable Gastric Band (LAGB).
Methods: A retrospective chart review performed at Baptist Health South Florida identified 63 patients ≥60 years old who underwent bariatric surgery from December 2008 to August 2012 by 2 different surgeons. We excluded patients undergoing planned open procedures or revisional bariatric surgery. Complications within 30 days were documented in all 63 patients and 45 (71.4%) had adequate follow up for analysis of the percentage of excess weight loss (%EWL) and change in body mass index (BMI) one to two years after surgery.
Results: The %EWL at one year was significant in each group, with small changes from year 1 to year 2 that were not statistically significant. Both RYGB and SG resulted in significantly higher average %EWL than LAGB with estimated differences two years post-surgery of 35.0 (p2less than LAGB at one-year follow-up (p=0.017) and 5.9 kg/m lower at two years (p=0.004). Complications were reported in 13 (20.6%) out of 63 cases, most were surgical occurring in 10 cases (15.9%) while 4 (6.3%) patients had medical complications. No deaths were reported in the 30-day postoperative period.
Conclusion: Our case series is consistent with the relatively new trend reported in the literature showing that percentage of excess weight loss and BMI reduction is comparable to what is reported for the younger population. RYGB seems to be the most effective surgery to achieve weight loss in older patients but is the procedure that carries more postoperative complications.
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Escobar-Dominguez, Jose; Gallas, Michelle; Seetharamaiah, Rupa; Rabaza, Jorge; Hernandez-Murcia, Christian; Gonzalez, Anthony; and Walker, Gail, "Determining the Best Bariatric Surgery for Older Patients" (2019). All Publications. 3273.