M. Abbas, MD, L. Cumella, BS, J. Choi, MD, P. Vemulapalli, MD, D. R Camacho, MD. Montefiore Medical center, Bronx, NY.
The number of obese older persons has markedly increased . Obesity has important functional implications in older men and women because it exacerbates the age-related decline in physical function and causes frailty or sarcopenic obesity. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Lifestyle intervention is just as effective in older as in younger subjects. Bariatric surgery is the most effective weight-loss therapy for obesity. The indications for bariatric surgery were established at a National Institutes of Health Consensus Conference held in 1999.
To evaluate the safety and efficacy of bariatric surgery performed at our institution, in patients older than 60 years of age. To determine the weight loss, rate of operation related complications and impacts of surgery on co-morbid conditions.
Departmental databases were queried to identify patients older than 60 years age who underwent bariatric surgery procedures. Only patients who underwent laparoscopic interventions were included in the analysis. Lap. Gastric band (LGBa), lap. Gastric Bypass (LGBP) and lap Sleeve Gastrectomy (LSG) were the procedures performed. Data evaluated at different pre and post-operative interval included age, sex, height, pre-op weight and BMI, presence of Co-morbid conditions DM, HTN, HL, asthma, OSA, procedures performed, mortality, immediate or delayed complications, length of follow up, weight/BMI points lost,% excess weight loss (%EWL), and effects on obesity related comorbid conditions.
Results: 98 patients were identified. 7 patients did not have any follow-up information available. 8 patients had LGBa, 30 had LSG and 53 underwent LGBP. Average age was 63.26 years, 70(78.2%) women, and 20(21.8%) patients were men. Average pre-op weight was 269.33 +/-54.21Lbs, Average Pre-O BMI 46.26kg/m2, Average Excess Body Weight was 88+/-45.30Lbs. Pre-existing comorbid conditions included DM in 55%, HTN in 78%, HL in 44%, OSA in 31%and asthma in 30% patients respectively. There were no operative deaths, there was 1 anastomotic leak, 1 patient had respiratory failure, 1 bleeding from G-J anastomosis requiring endoscopic intervention. Complications within one year of surgery included 4 episodes of SBO requiring abdominal exploration and LOA, one of them was secondary to internal hernia, 4 G-J anastomotic strictures requiring endoscopic dilatation. Average 5 Excess Weight Loss(%EWL) at 3 months was 29.80+/- 9, at 6 months 59.18+/-30.65, at one year 62.70+/-26.25 and 66.22+/-30.42 at 2 years intervals. 30.91 patients suffering from DM reported resolution, 61.82% reported improvement and 7.27% reported no difference. 78.21% patients with HTN reported resolution, 14.10% reported improvement and 7.69% no change. 18.18% reported resolution of HL, 72.73% improved and 13.64% reported no change. 6.45% patients with OSA reported resolution, 87.10% reported improvement and 6.45% no change.
In our experience bariatric surgery is 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.