Bariatric surgery is safe and effective in older adults,
yielding results on par with younger patients, according to the
first long-term outcomes study of bariatric surgery versus medical
management in severely obese patients age 60 or older.
In these older patients, laparoscopic Roux-en-Y gastric bypass
(RYGB) and sleeve gastrectomy were associated with low complication
rates and provided far greater weight loss and diabetes remission,
as expected, than medical management of severe obesity.
"We were pleasantly surprised that the outcomes we see in
younger patients were very nicely reproduced in this older age
group of patients," Dr. Anthony Petrick, director of bariatric and
minimally invasive surgery at Geisinger Medical Center in Danville,
Pennsylvania, told Reuters Health.
"There is always the potential that older patients are going to
have more problems in terms of their complications. We felt that
even some of the cost issues around having longer length of stays
or readmissions would be different, but we did not find a
difference," Dr. Petrick said in a phone interview.
"About the only thing that we found was that when patients had
open gastric bypass, they did have a slightly higher complication
rate; but open gastric bypass surgery is going far back in our
cohort of patients. About 8 years ago we stopped doing open gastric
bypass, and this pretty much parallels what is happening in the
United States. Laparoscopic bariatric procedures have become the
norm," said Dr. Petrick.
He presented the study findings November 2 at
Obesity Week 2017, hosted by the American Society for Metabolic
and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).
Dr. Petrick and colleagues did a retrospective analysis of 919
mostly female patients age 60 or older with severe obesity (BMI
around 46); 190 underwent laparoscopic RYGB, 115 had open RYGB and
32 had sleeve gastrectomy. The remaining 582 did not have surgery.
Median follow-up was 56 months.
In the surgery group as a whole, 16 per cent had minor
complications and 5.6 per cent had major complications, comparable
to rates seen in younger patients.
At 36 months, surgery patients had lost 62 per cent of their
excess weight compared with excess weight loss of just 5.3 per cent
in non-surgery patients. "This weight loss with surgery is very
similar to younger patients," Dr. Petrick said.
"In addition, surgery patients averaged a decrease in three
medications a year after surgery, whether for diabetes or
hypertension. Patients who didn't have surgery averaged one
additional medication at one year," he told Reuters Health. "There
was almost no diabetes remission with medical management compared
with 46 per cent with surgery."
There were 25 deaths during the 10-year study period (2007 to
In multivariate analysis, overall survival at 10 years was
better with surgery than without. "There is this thought that when
you are 60, 65 or 70 years old, what difference does surgery make?
But even at 120 months - 10 years - these patients had
significantly better survival than patients who did not have
surgery," Dr. Petrick said.
"Just in terms of surgery itself, it seemed to be safe to do
either lap sleeve or lap gastric bypass, and that's an important
finding because it means that in our elderly patients we don't
limit our options for these folks if they are morbidly obese and
have medical problems," Dr. Petrick said.
"With the graying of America, more seniors will continue to turn
to bariatric surgery to treat their obesity and related diseases
including type 2 diabetes.
"This study provides further evidence that they can do so with
confidence," Dr. Eric DeMaria, director of bariatric surgery at Bon
Secours Maryview Medical Center in Portsmouth, Virginia, who was
not involved in the study, said in a news release.
- Reuters Health