Is Bariatric Surgery Safe in the Elderly Population?

Federico Perez Quirante, MD, Lisandro Montorfano, MD, Rajmohan Rammohan, MD, Nisha Dhanabalsamy, MD, Alex Ordonez, MD, Aaron Lee, MD, Abraham Abdemur, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul J Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida

Background: The aim of our study is to report the outcomes of bariatric surgery in patients over 65 years of age at our Institution.

Methods: A retrospective review of a prospectively collected database of the patients who underwent bariatric surgery at our institution from December 2010 to November 2014was performed. The data analyzed included age, preoperative body mass index, post-operative complications, and comorbidities.

Results: Of the 1139 patients identified 981 were younger than 65 years of age and 158 were older than 65 years of age. Of these patients there was a significant difference in the gender ratio, 42% of the >65 were males in comparison to 31% males in the under 65 group (p= 0.004). Caucasian represented the majority of our patients 52% in the cohort less than 65,but 85% in the cohort over 65 (p<0.001). The over 65 patients had a lower preoperative BMI (Mean=39 – Range 37-44) than younger patients (Mean=42 – Range 38-48) (p<0.001).

In the >65 group there were a higher incidence of comorbidities when compared to the <65 group. In particular the statistically significant differences were in Hypertension (p<0.001), Sleep apnea (p<0.001), CAD (p<0.001), Heart failure (p< 0.001), Myocardial infarction (p< 0.001), Diabetes II (p=0.035), Dyslipidemia (p<0.001), Hyperlipidemia (p<0.001), Hypercholesterolemia. No difference however was found in the presence of GERD (p=0.051) or history of DVT/PE (P=0.2)
When the rate of each procedure was analyzed (LSG, LRYGB, LGB, Revisions) significant difference was found in the >65 group with 22% of them undergoing revisional surgery when compared to 14 % for <65 (p=0.017). Also, elderly patients stayed on average one day more after their surgery (LOS=3days, p=0.037) But no significant difference were found in the rate of readmission (12% vs. 11%) (p=0.7),wound infection (2% vs. 4%) (p=0.28), obstruction (2% vs. 4%) (p=0.24), jejunal ulcer (2% vs. 3%) (p=0.69), gastric ulcer (2% vs. 3%) (p=0.15), nausea (15% vs. 13%) (p=0.49), vomiting (13% vs. 9%) (p=0.18), abscess (3% vs. 4%) (p=0.5), dehydration (6% vs. 7%) (p=0.68) and new GERD (6% vs. 4%) (p=0.4). Only the incidence of fistulas was higher in the >65 group (4% vs. 2%) (p=0.039)

Conclusion: Elderly patients present for surgery significantly sicker in terms of comorbidities than the younger population. However age seems to represent no risk for surgical complications after a bariatric surgery. Revisional surgery is more prevalent in elderly patients and this explains the higher incidence of fistulae.

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