Bariatric Surgery in the elderly is associated with similar surgical morbidity and significant long term health benefits

Uri Kaplan¹, Scott Penner², Forough Farrokhyar¹, Scott Gmora¹, Dennis Hong¹, Mehran Anvari¹. ¹Mcmaster University, ²Dalhousie University

Background:

Older age (>60) has been a relative contraindication for bariatric surgery due to an increased risk of complications. Recent data shows that this may not be the case, and in fact reveals some encouraging results.

Methods:

The Ontario Bariatric Registry is a prospective data registry recording the peri-operative and postoperative outcomes of all patients undergoing bariatric surgery in 5 Centers of Excellence and 4 Assessment centers across the province. We compared operative and postoperative outcomes of bariatric surgery in patients over the age of 60 with outcomes of younger patients who had undergone Laparoscopic Gastric Bypass (LRYGB) and Laparoscopic Sleeve Gastrectomy (LSG) between January 2010 and May 2013.

Results:

3166 patients underwent LRYGB or LSG between January 2010 and May 2013 and completed their one year follow-up. 204 (6.5%) of these patients were greater than 60 years of age. Of these, 175 (85.8%) underwent LRYGB and 29 (14.2%) had LSG. Demographics of patients over 60 were the same as those in the younger cohort, except for a higher number of males in the older population (59 (28.9%) vs. 452 (15.3%) (p<0.001)). No significant difference was noted in the rate of peri-operative and post-operative complications (15% in the younger cohort versus 13.8% in patients >60 years of age (p=0.889)). The average percentage of excess weight loss was significantly higher in the younger population (60.72% vs. 56.25%(p<0.05)). This difference was not significant in the population that underwent LSG. The total reduction in the amount of medication use for management of comorbidities such as diabetes mellitus, hypertension and hypercholesterimia after bariatric surgery was significantly higher in the older patients (- 0.91 vs -2.03 (p<0.001)). A sub-analysis of age groups above the age of 60 did not showed any difference in results (ages 61-65 and above 65).

Conclusion:

In patients above the age of 60, Laparoscopic bariatric surgery is a safe and effective. LSG has the same effect on weight loss as LRYGB in the older patients. There is a trend towards improvement of cardiovascular disease and diabetes mellitus after LRYGB in the older population as inflicted from the reduction in the amount of medication. Preliminary results show that the risk and benefit of bariatric procedures for patients between the ages of 61-65 is the same as of patients between the ages of 65-69.

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