Salim Hosein, MD1, Behram Khan2, Jessica Pries, MD1, Alaa Mohammed, MPH1, William S Richardson, MD, FACS1. 1Ochsner Clinic Foundation, 2Ochsner Clinical School, University of Queensland
Background: Historically, the risk-benefit ratio of bariatric surgery was thought to favor patients under 55 and older patients were denied surgery. Recent studies have demonstrated good bariatric outcomes over 65. How older patients compare to younger, is not well studied.
Aim: Rather than compare patients above 65 to below that age, we felt it more valid to have two distinct age groups. We studied our outcomes in patients over 65 undergoing laparoscopic sleeve gastrectomy (LSG) and compared these to a cohort of patients under 35, to evaluate for safety and effectiveness in terms of both weight loss and resolution of preoperative comorbidities.
Methods: We conducted a review of a prospectively collected database of patients aged over 65 (Group A) who had a LSG between 2012-2016 and compared them to controls under 35 (Group B). Cases were identified from medical record data by CPT code. Change in body mass index (BMI), complications, resolution of comorbidities and excess body weight loss (EBWL) were compared. Follow-up extended up to 6 months post-operatively.
Results: Group A had 64 patients (mean age 68.8, range 66-76) and Group B had 212 (mean age 32, range 18-34). 75% of Group A and 88% of Group B were female (p=0.01). Decrease in post-operative BMI averaged 7.6 for Group A versus 10.8 for Group B (p<0.001). Mean EBWL was comparable between groups (43% vs 45%, p=0.51). Diabetes (DM) resolution, measured by normalization of preoperatively elevated glycosylated hemoglobin, was observed in 52% of patients in Group A and 33% in Group B (p=0.11). Hypertension (HTN) resolved in 58% of patients in Group A and 68% in Group B (p=0.20) and obstructive sleep apnea (OSA) resolved in 29% of affected patients in Group A and 37% in Group B (p=0.44). Mean decrease in triglyceride level was 79.5 mg/dL in Group A versus 40.9 mg/dL in Group B (p<0.001). Complication rates were 7.8% for Group A and 4.2% for group B (p=0.33), the majority being minor wound complications. 1 myocardial infarction and 1 venous thrombosis (DVT) occurred in Group A while 2 DVTs and 1 case of pancreatitis were the major complications in Group B.
Conclusions: LSG results in comparable EBWL and resolution of DM, HTN and OSA in both cohorts. Average BMI decrease favors the younger cohort while improvements in triglyceride level favors the older group. In appropriately selected older patients, LSG has comparable outcomes and rare major complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87317
Program Number: P605
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster