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Which procedure?

Sex and age significantly impact surgical outcomes

Sex predicted remission in the bypass but not the sleeve group
Increasing age was associated with a reduced odds of diabetes remission in the sleeve but not the bypass group
Males reported greater rates of T2DM remission than women when they received a sleeve rather than a bypass

Patient gender and age significantly contribute to the success of bariatric surgery in a procedure-dependent manner, according to a study, 'Age- and sex-specific effects on weight loss outcomes in a comparison of sleeve gastrectomy and Roux-en-Y gastric bypass: a retrospective cohort study', published in BMC Obesity. The outcomes could have important implications for patients when choosing which surgery to receive.

“Our results demonstrate that patient sex and age significantly impact on weight loss and diabetes remission in a procedure-dependent manner,” the authors write. “These findings provide a strong basis for a further prospective randomised study, which could definitively address whether individualisation of procedure selection, using age- and sex-specific criteria, could achieve better outcomes than standard care.”

The researchers from University College London, St Anthony’s Hospital, North Cheam, UK and University of Alexandria, Egypt, wanted to compare weight loss outcomes between bypass and sleeve, and to define patient factors affecting weight loss.

In the single-centre, two-year follow-up retrospective study patients who either had a bypass (n=422) or sleeve (n=432). The results at one- and two-year showed that unadjusted BMI loss was similar between groups; 13.7 and 12.8 for bypass patients, compared with 13.3 and 11.5 for sleeve patients, respectively.

Although, when adjusted for pre-operative BMI, there was 2.2 and 2.3 greater BMI loss in the bypass  group compared to the sleeve group at one and two years respectively (both p< 0.001). The interaction analyses demonstrated that age and sex had important differential impacts on sleeve and bypass weight outcomes.

They also reported that sex and age also impact upon T2DM remission in a procedure-specific manner: sex predicted remission in the bypass (p=0.039) but not the sleeve group (p=0.83) and increasing age was associated with a reduced odds of diabetes remission in the sleeve (p=0.032) but not the bypass group (p=0.47).

“We have identified clinical characteristics that could influence procedure selection between RYGBP and SG for patients undergoing bariatric surgery,” they write. “In terms of weight loss, men <40 and women ≥50 years obtained on average less benefit from sleeve compared to bypass. In contrast, men ≥ 40 years and women < 50 years experienced similar weight loss with either procedure.”

They also note that on a sub-group analysis of patients with T2DM remission, males reported greater rates of remission than women when they received a sleeve rather than a bypass.

“Optimising procedure selection could enhance the effectiveness of bariatric surgery, thus further increasing the benefit-to-risk ratio of this highly effective intervention,” the authors conclude. “Investigation of the mechanisms underlying age- and sex-specific aspects of the differential procedure responses is warranted.”

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