Bariatric Surgery Is Effective and Safe in Patients Over 55: a Systematic Review and Meta-analysis

Abstract

Effective weight loss and reduction in comorbidities has been convincingly demonstrated with bariatric surgery. Concerns regarding increased perioperative complications and poor results have led to a reluctance to offer such surgery to older patients. We performed a systematic review and meta-analysis of the published evidence for those in the ≥55-year age group. An electronic search was conducted of MEDLINE, EMBASE, and the Cochrane Library databases from 1990 to December 2010. We included laparoscopic studies published in English where the results were broken down by surgical procedure, reporting a minimum 6-month follow-up for ≥10 patients aged ≥55. After an initial screen of 2,543 titles, 298 abstracts were reviewed. Eighteen studies were included in the analysis. Of these, 10 included patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) (663 patients), and 11 included patients undergoing laparoscopic adjustable gastric banding (LAGB) (543 patients). Meta-analyses of body mass index (BMI) reductions indicated sustained and clinically significant BMI reductions for both RYGB (mean percentage of excess weight loss at 1 year, 72.6 %) and LAGB (mean percentage of excess weight loss at 1 year, 39.1 %). The 30-day mortality was 0.30 and 0.18 % for LRYGB and LAGB, respectively. Meta-analysis of old versus young patients revealed better comorbidity and mortality outcomes for younger patients. Bariatric surgery for patients ≥55 years achieves weight loss and reduction in comorbidities and mortality comparable to the general bariatric surgery population. Based on the above findings, patients should not be denied bariatric surgery on the basis of age alone.

Does Age Influence Bariatric Surgery Outcomes?

“…13,23 This study also revealed similar findings regarding presurgical comorbidities. Patients in groups 2 and 3 had a higher prevalence of hypertension, type II diabetes mellitus, dyslipidemia, arthritis, and OSA than did patients in group 1.…”

“…Most previous studies have focused on gastric bypass surgery when investigating the impact of age on bariatric surgery outcomes. 23 Very few publications have included SG in their study. 24 There are very scarce data available comparing the differences in outcomes of gastric bypass and SG.…”

Definitions of obesity and current indications for obesity surgery

“…Due to the perceived complication risks and poor outcomes of surgery, most bariatric surgeons are frightened to propose bariatric surgery to older patients. [46] Although age limit is shown by European Guidelines on Metabolic and Bariatric Surgery as between 18 to 60 years of age in adults, no higher age limit for bariatric surgery was recommended in the NIH conference in 1991. [17,19,26] At the time of publication, there was insufficient data to make a recommendation for or against surgery for adolescent population.…”

“…[47] In light of the current studies, metabolic and bariatric surgery should be performed on selected patients aged 65 and older. [17,19,46] Baur et al recommenda minimum of 15 years of age for adolescents. Since the effects of bariatric surgery is unknown among preadolescents, it is not recommended for this group.…”

Indication of Bariatric Surgery (Roux-en-Y Gastric Bypass Surgery and Vertical Gastrectomy) in The Older Individuals and implications For Gut Microbiota

“…Surgery results in greater weight loss and improvement in weight-related comorbidities in comparison to non-surgical interventions, regardless of the type of procedure adopted [2,3]. Nonetheless, the indication of bariatric surgery in people aged over 65 years is still controversial and subject to discussion, and should be considered very carefully, although studies have shown that individuals older than 55 years are comparable to bariatric patients in the general population [4,5]. Caution should taken as the elderly present alterations of the gastrointestinal tract and microbiota that are inherent to the aging process, such gastric mucosa atrophy, causing lower production of hydrochloric acid and decreased absorption of vitamin B12, as well as reduced peristalsis, intestinal constipation and dysbiosis [1].…”