Simon C Chow, MD, Kevin M Reavis, Emma J Patterson, MD, Jay C Jan, MD, Valerie J Halpin, MD. Legacy Good Samaritan Medical Center
Background: The literature is divided with respect to outcomes regarding laparoscopic Roux-en-Y gastric bypass surgery in the elderly. Some studies have demonstrated excess weight loss and complication rates comparable to the non-elderly population, whilst other studies have shown increased mortality. Furthermore, some centers/surgeons may be hesitant operating on elderly patients as there may be a perceived increased perioperative risk. The aim of this study is to analyze the safety of gastric bypass in patients at our institution, comparing patients aged 65 years (OVER65) and over versus patients under 65 (UNDER65).
Methods: A retrospective analysis of a prospectively maintained database of all patients who had undergone gastric bypass between July 2008 and June 2014 was performed. The variables analyzed included demographics, comorbidities, and 30-day complication rates. Serious complications were considered Clavien III and above with the need for reintervention and included anastomotic leaks, gastrointestinal or intraabdominal bleeds, marginal ulcers and strictures, bowel obstruction and intraabdominal abscesses. Logistical regression was used for statistical analysis. Statistical significance was defined at p<0.05.
Results: There were a total of 1247 subjects who had a gastric bypass, of which 186 were in the OVER65 group. The OVER65 group had higher rate of comorbidities including diabetes, hypertension, dyslipidemia compared to the UNDER65 group (Table 1):
|Age in years (range)||67.9 (65-75)||46.3 (18-64)||0.007*|
|Obstructive sleep apnea||81.7%||72%||0.15|
|Patients with complications||16 (8.6%)||54 (5.1%)||0.058|
|Patients with Clavien class III and above complications||8 (4.3%)||29 (2.7%)||0.25|
On logistic regression diabetes, hypertension or obstructive sleep did not affect the overall complication rate (p>0.05). The presence of dyslipidemia did correlate with increased risk of complications (p=0.04). There was a trend towards an increased complication rate associated with age, but this did not meet statistical significance. There was no mortality in either group.
Conclusions: Laparoscopic Roux-en-Y gastric bypass performed in patients over 65 years of age is a safe procedure. The 30-day morbidity and mortality are not significantly different between the OVER65 and UNDER65 groups at our institution.