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Safety and Efficacy of Bariatric Surgery in Older Patients

Sarah P Shubeck, MD1, Ruth Cassidy, MS1, Daniel Bacal, MD2, Amir Ghaferi, MD, MS1, Jonathan Finks, MD1. 1University of Michigan, 2Beaumont Hospital

Introduction: Bariatric surgery remains the most effective treatment for morbid obesity. Improvements in safety over the past decade have led to a dramatic increase in the number of procedures performed. However, the safety and effectiveness of bariatric surgery in older patients remains uncertain. We sought to evaluate the outcomes of bariatric surgery in older patients using a statewide clinical registry.

Methods: We utilized data from the Michigan Bariatric Surgery Collaborative (MBSC) prospective clinical registry to study 20,557 patients undergoing primary Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric band procedures between June 2006 and July 2016. In order to determine clinically meaningful age groups, we polled practicing surgeons in the MBSC and the broader SAGES community (SAGES Foregut Surgical Collaboration Facebook Group) to assess their age limit for offering bariatric surgery. Based on surgeon responses, we stratified patients into three categories: <45 (8,463 patients), 45-69 (11,809 patients), and >70 (285 patients).

Results: The majority of responding surgeons (71%) did not have a age requirement cutoff for patients to be considered for bariatric surgery. However, surgeons consistently reported age 70 as a relative upper limit for offering these procedures. In our analysis, patients over the age of 70 undergoing bariatric procedures had higher rates of comorbidities including cardiovascular disease, musculoskeletal diagnoses, and diabetes mellitus compared to younger patients. In all procedures, patients over the age of 70 had higher rates of any post-operative complication than patients in the 45-69 age group (<45: 7.3%, 45-69: 7.0%, >70: 9.5%), but did not have a significant increase in rate of “serious” complications such as bowel obstruction, leak, significant bleeding, and VTE (<45: 2.1%, 45-69: 2.2%, >70: 3.7). Although patients over 70 had less excess weight loss at 1 year than younger patients (<45: 60.9%, 45-69: 58.1%, >70: 54.3%), they benefitted from similar rates of discontinuation of insulin (<45: 42%, 45-69: 44%, >70: 50%), oral diabetes medications (<45: 26%, 45-69: 32%, >70: 33%), cholesterol lower medications (<45: 40%, 45-69: 51%, >70: 61%), and continuous positive airway pressure devices for Obstructive Sleep Apnea (<45: 37%, 45-69: 47%, >70: 54%).

Conclusion: Despite increased multimorbidity and lower percent excess weight loss at one year, patients over age 70 benefited from comparable rates of comorbidity resolution as younger patients without significant increase in “serious” complications. These findings suggest that bariatric surgery is safe in older adults and provides similar overall health benefits as experienced by younger cohorts.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 77799

Program Number: S078

Presentation Session: SAGES Got Talent : Resident & Fellow Scientific Session

Presentation Type: ResFel

36

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