Original articleRoux-en-Y gastric bypass is safe in elderly patients: a propensity-score matched analysis☆
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.
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Cited by (14)
Is laparoscopic bariatric surgery as safe and effective before and after age 60? Results from a propensity-score analysis
2022, Surgery for Obesity and Related DiseasesCitation Excerpt :According to U.S. and Swedish registry data [9,19], age >45 years is associated with an increased risk of major postoperative complications and mortality in the United States [19], whereas in Sweden the age limit is different depending on whether surgical complications (<50 years of age) or medical complications (<60 years of age) are included [9]. In contrast, neither Hassinger et al. [25] nor Goldberg et al. [9] in their propensity-score studies reported a significant difference in terms of surgical complications and reoperation after RYGB in elderly patients. Several elements can explain these results.
Association of metabolic–bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants
2021, The LancetCitation Excerpt :We also elected to exclude the study by Sheetz and colleagues38 because it focused exclusively on patients with pre-existing end-stage renal failure; we considered the characteristics of this extremely high-risk patient population and the interventions they received (such as a much higher rate of kidney transplant procedures) to be vastly different from all other studies, and decided that its inclusion would only render the pooled treatment effects difficult to interpret and generalise. In total, 17 articles were included, of which eight (coarsened exact) matched with user-specified bins,27,29,31,62–65 four used propensity-score matching,25,32,66–68 two employed sequential stratification matching,28,30 one matched on the Mahalanobis distance metric,26 one had greedy nearest neighbour matching,33 and one study was a prospective controlled trial24 that used sequential treatment assignment to create a contemporaneously-matched control group. Patient characteristics and intervention details are summarised in the appendix (pp 42–46).
Comment on: Bariatric surgery in the elderly: a randomized prospective study comparing safety of sleeve gastrectomy and Roux-en-Y gastric bypass (BASE Trial)
2020, Surgery for Obesity and Related DiseasesIs age a real or perceived discriminator for bariatric surgery? A long-term analysis of bariatric surgery in the elderly
2019, Surgery for Obesity and Related DiseasesOutcome of bariatric surgery in older patients
2018, Surgery for Obesity and Related DiseasesCitation Excerpt :Another important common feature of obesity and aging is the development of resistance to certain hormones, such as insulin and leptin, which triggers metabolic dysregulations, such as type 2 diabetes, and failure to regulate food intake as well as fat distribution [27]. Several studies have explored the safety and efficacy of bariatric surgeries in elderly patients [28–31], whereas controversial findings are reported that indicate an increase in short-term mortality in the elderly after a bariatric surgery [32]. These studies evaluated the mortality, morbidity and effectiveness of bariatric surgeries in elderly patients.
Approach to Obesity in the Older Population
2021, Journal of Clinical Endocrinology and Metabolism
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The National Institutes of Health under Award Numbers T32 HL007849 and T32 CA163177 supported research reported in this publication.