Jb1176

Older Age and Gastric Surgery

2 posts in this topic

Is there a maximum age at which gastric surgery is no longer performed? I am 72 and scheduled for banding next month. The sleeve and bypass were not options for me according to my surgeon. Any advice for older patients going into banding surgery?

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Dear Jb,

 

As a general rule, age is only a relative factor. Most surgeons think more of "physiological" age than chronological age. In other words, one's general health and ability to tolerate the surgery is the key, and age is just one of many factors to take into consideration. There may be higher complication rates in the elderly, but not to the extent that surgery should not be considered. We have done Lap-Bands, sleeve gastrectomies, and gastric bypasses in patients in their 70's with good results. These patients have all passed careful medical evaluation including cardiac and pulmonary testing.

 

I've included the summaries of three journal articles on the subject.

 

Dr. Callery

 

 

Obes Surg. 2014 Oct;24(10):1662-9. doi: 10.1007/s11695-014-1247-5.
Gastric bypass for obesity in the elderly: is it as appropriate as for young and middle-aged populations?
 

 

Abstract
BACKGROUND: 

Obesity prevalence increases in elderly population. Bariatric surgery has been underused in patients over 60 because of fears of complications and lower weight loss. We postulated worse outcomes in the elderly in comparison to young and middle-aged population 1 year after gastric bypass.

METHODS: 

We retrospectively analyzed gastric bypass outcomes in young (<40 years), middle-aged (40 to 55 years), and elderly (>60 years) patients between 2007 and 2013. Each subject over 60 (n = 24) was matched with one subject of both the other groups according to gender, preoperative body mass index (BMI), surgical procedure, and history of previous bariatric surgery (n = 72).

RESULTS: 

Older subjects demonstrated higher prevalence of preoperative metabolic comorbidities (70 vs 30 % in the <40-year-old group, p < 0.0001). Mean duration of the surgical procedure, mean length of stay, and early and late complication rates were similar between age groups. A trend towards fewer early complications and less-severe complications in the younger groups was noted. One-year weight loss results were similar between young, middle-aged, and elderly patients (percentage of excess BMI loss (EBL%), 74.4 ± 3.5; 78.9 ± 4.5, and 73.7 ± 4.5 respectively, p = 0.69). Age was not predictive of weight loss failure 1 year after surgery. Remission and improvement rates of comorbidities were similar between age groups 6 months after surgery.

CONCLUSIONS: 

Our study confirms weight loss efficacy of gastric bypass in the elderly with acceptable risks. Further studies evaluating the benefit-risk balance of bariatric surgery in the elderly population will be required so as to confirm the relevance of increasing age limit.

 

_______________________________________________________________________________________________________________

 

Obes Surg. 2015 Mar;25(3):406-12. doi: 10.1007/s11695-014-1462-0.
Advanced Age as an Independent Predictor of Perioperative Risk after Laparoscopic Sleeve Gastrectomy (LSG).
 

 

Abstract
BACKGROUND: 

While the safety of many bariatric procedures has been previously studied in older patients, we examine the effect of advancing ageon medical/surgical complications in laparoscopic sleeve gastrectomy, a relatively unstudied procedure but that is trending upwards in use.

METHODS: 

Patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (RYGB) were extracted from the National Surgical Quality Improvement Program 2005-2012 database. Pre- and postoperative variables were analyzed using chi-square and student t test as appropriate to determine the comparative safety of LSG to RYGB in the elderly. Multivariate regression modeling was used to evaluate whether age is associated with adverse 30-day events following LSG.

RESULTS: 

Of the patients that met the inclusion criteria, 56,664 (84 %) patients underwent RYGB and 10,835 (16 %) underwent LSG. In the LSG cohort, incidence of overall complications, medical complications, and death significantly increased with increasing age (p < 0.05). No statistically significant differences in rates of 30-day complications, return to the OR, and mortality exist between RYGB and LSG cohorts in patients older than 65 years. The age group of over 65 years independently predicted increased risk for overall and medical complications (OR, 1.748; OR, 2.027). Notably, age was not significantly associated with surgical complications in LSG.

CONCLUSION: 

In this large, multi-institutional study, advanced age was significantly associated with overall and medical complications but not surgical complications in LSG. Our findings suggest that the risk conferred by advancing age in LSG is predominantly for medical morbidity and advocate for improved perioperative management of medical complications. LSG may be the preferable option to RYGB for elderly patients as neither procedure is riskier with regards to 30-day morbidity while LSG has been shown to be safer with regards to long-term reoperation and readmission risk.

________________________________________________________________________________________________________________

 

J Am Assoc Nurse Pract. 2015 Mar 4. doi: 10.1002/2327-6924.12235. [Epub ahead of print]

A review of the safety and efficacy of bariatric surgery in adults over the age of 60: 2002-2013.
Abstract
PURPOSE: 

The purpose of this review is to compare outcomes of bariatric surgery in adults over 60 to younger patients. This analysis is important to determine if nurse practitioners (NPs) and other providers should recommend bariatric surgery to obese older adults.

DATA SOURCES: 

This review included 15 studies published between 2002 and 2013.

CONCLUSIONS: 

Although older adults seem to experience less weight loss, bariatric surgery has potential benefits for these patients. Significant improvements in hypertension, diabetes, and, to a lesser extent, dyslipidemia are noted. Mortality and surgical complications in older adults are low, while differences in length of hospital stay are inconclusive.

IMPLICATIONS FOR PRACTICE: 

The risks of bariatric surgery in older adults need to be carefully evaluated based on individual medical condition. Overall the evidence suggests that bariatric surgery can be safely performed in older adults but more research is needed to determine which older adult patients are the best candidates for bariatric surgery. As bariatric surgery among older adults increases, interdisciplinary teams will continue to serve an important role in the management of bariatric surgery patients. NPs must be aware of trends in this emerging population of bariatric surgery patients.

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