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Surgery in older patients

Bariatric surgery effective in patients older than 60

When results were compared to the general population, there was no significant difference in the number of complications that occurred within each of the two groups

Bariatric surgery can be safe and effective for patients older than 60 years of age with a low morbidity and mortality; the weight loss and improvement in comorbidities in older patients were clinically significant. The paper, ‘Outcomes of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Patients Older than 60’, was published in Obesity Surgery. The study researchers from Montefiore Medical Center noted that a large proportion of patients reported resolution or improvement in comorbid conditions.

When results were compared to the general population, there was no significant difference in the number of complications that occurred within each of the two groups. The difference in %EWL at the 12-month follow-up was not statistically significant between the general population and the older patients, which suggests that both groups lost a similar amount of weight and that bariatric surgery on patients who are above the age of 60 is effective.

Diego Camacho

“The proportion of the population older than 60 years is rapidly increasing and the majority of this older population suffers from multiple comorbid conditions including obesity,” said Dr Diego Camacho, director of Minimally Invasive and Endoscopic Surgery at Montefiore Medical Center. “Non-surgical means of weight loss does not offer a predictable solution. Instead, surgical interventions seem to be the most promising solution for the obesity problem, but there is a relative lack of data in literature regarding bariatric procedures in older populations.”

A retrospective review of patients’ medical records were used to collect data to create databases to identify patients older than 60 years age who underwent bariatric surgery procedures spanning a four-year period between January 2009 and October 2013. Data reviewed included age, sex, height, pre-operative weight and body mass index (BMI), presence of obesity-related comorbid conditions, procedures performed, mortality, immediate or delayed complications, length of follow-up, excess weight lost, BMI points lost, percent of excess weight loss (%EWL), hemoglobin Alc (HgbA1c), and effects on obesity-related comorbid conditions. The percent of excess weight loss and number of complications within the older patient group were compared to the general population, which consists of patients between the ages of 22 and 59.

Overall, 83 patients who were above the age of 60 were examined; 30 patients had laparoscopic sleeve gastrectomy (LSG), and 53 patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). The average patient age was 63.4 years, the average pre-operative weight was 122.3 kg and the average excess body weight was 54.8 kg. The pre-existing comorbid conditions included 90.4 % hypertension (HTN), 63.9 % diabetes mellitus (DM), 50.6 % hyperlipidemia (HL), 34.9 % obstructive sleep apnea (OSA), and 30.1 % asthma. The average %EWL at three months, six months and 12 months was 37.0, 51.3, and 65.2 %, respectively. A significant proportion of patients reported resolution or improvement in comorbid conditions.

The researchers noted that the long-term effects of such interventions will need further studies and investigations.

In addition to Dr Camacho, the study was conducted by Dr Jenny Choi, Pratibha Vemulapalli, W Scott Melvin, Lindsay Cumella and Yang Zhang.

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