Original article
Roux-en-Y gastric bypass is safe in elderly patients: a propensity-score matched analysis

https://doi.org/10.1016/j.soard.2018.03.032Get rights and content

Highlights

  • Similar rates of complications following RYGB in elderly and non-elderly adults

  • Weight loss benefit for elderly patients after RYGB versus non-surgical controls

  • No survival difference for elderly patients after RYGB versus non-surgical controls

Abstract

Background

Numerous studies have established the effectiveness of Roux-en-Y gastric bypass (RYGB) for weight loss and co-morbidity amelioration. However, its safety and efficacy in elderly patients remains controversial.

Objectives

To evaluate outcomes in patients aged ≥60 years who underwent RYGB compared with nonsurgical controls with the hypothesis that RYGB provides weight loss benefits without differences in survival.

Setting

University-affiliated tertiary center.

Methods

All patients who underwent RYGB from 1985 to 2015 were identified and divided into elderly (age ≥60) and nonelderly (age <60) groups. A nonsurgical elderly control population was identified using a clinical data repository of outpatient visits to propensity match elderly patients 4:1 on demographic characteristics, co-morbidities, and relevant preoperative substance/medication use. Unpaired appropriate univariate analyses compared each stratified group. Kaplan-Meier survival curves were fitted based on social security death data.

Results

A total of 2306 patients underwent RYGB. The 107 elderly patients had lower median body mass index (47.0 versus 49.9; P = .007) and higher rates of co-morbidities. Rates of complications did not differ between elderly and nonelderly patients. Elderly surgical patients were propensity matched 4:1 (10,044 controls) yielding 428 well-matched nonsurgical controls. The elderly group demonstrated significant percent reduction in excess body mass index compared with the control group (81.8% versus 10.3%; P < .001). Kaplan-Meier survival analysis with log-rank test demonstrated no difference in midterm survival (P = .63).

Conclusions

A significant weight reduction benefit was identified after RYGB in elderly patients without a difference in midterm survival compared with propensity-matched controls, suggesting RYGB is a safe and efficacious weight loss strategy in the elderly.

Section snippets

Patients

All patients >18 years of age who underwent RYGB for morbid obesity at a single academic institution between 1985 and 2015 were retrospectively identified from a prospectively maintained database [11]. This surgical group was divided into elderly (age ≥60 yr) and nonelderly (age <60 yr) patients. To select an appropriate elderly control group, an institutional clinical data repository (CDR) of all routine outpatient visits from 2005 to 2015 was used to identify a nonsurgical cohort of 10,044

Results

A total of 2306 patients underwent RYGB during the study period, and 107 patients were elderly at time of surgery. Elderly patients had a lower median preoperative BMI (47.0 versus 49.9 kg/m2; P = .007) compared with the nonelderly surgical patients, and all relevant co-morbidities were more common among the elderly patients (Table 1). There were no significant differences in rates of postoperative complications—including bleeding, infection, and anastomotic/staple line leaks—between the

Discussion

This single-institution study of adults with morbid obesity identified higher rates of preoperative medical co-morbidities in elderly patients undergoing RYGB compared with nonelderly patients; however, the groups did not differ in rates of postoperative complications. While the elderly patients experienced a greater %REBMI, their time of follow-up was less than that of their younger counterparts. Among the matched cohorts of elderly patients, RYGB resulted in superior %REBMI compared with the

Conclusion

This study of adults with morbid obesity identified higher rates of preoperative co-morbidities among elderly patients undergoing RYGB compared with nonelderly patients without a difference in postoperative complications. Additionally, a major weight loss benefit in elderly patients with morbid obesity was identified after RYGB compared with a nonsurgical group of matched controls without a difference in overall midterm survival. These data help to more clearly define the role of bariatric

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (26)

  • JE Contreras et al.

    Correlation between age and weight loss after bariatric surgery

    Obes Surg

    (2013)
  • S Giordano et al.

    Bariatric surgery in elderly patients: a systematic review

    Clin Interv Aging

    (2015)
  • JH Mehaffey et al.

    10-year outcomes after Roux-en-Y gastric bypass

    Ann Surg

    (2016)
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    The National Institutes of Health under Award Numbers T32 HL007849 and T32 CA163177 supported research reported in this publication.

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