Bariatric Surgery Outcomes in Patients Aged 65 Years and Older at an American Society for Metabolic and Bariatric Surgery Center of Excellence

O'Keefe, Kathryn L.; Kemmeter, Paul; Kemmeter, Kimberly

doi:10.1007/s11695-010-0201-4

Cited by 109 publications

(55 citation statements)

References 14 publications

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“…One patient had an elevated blood pressure postoperatively during their hospital stay, and the other reported nausea and vomiting within the first 6 weeks postoperatively. We had no reports of mortality in the Medicare age group associated with SG which is concurrent with other studies examining the same population [2][3][4]. The younger age group (n0751) had 15 major complications, but none were reported in the Medicare age group.…”

supporting

confidence: 81%

Outcomes of the Laparoscopic Sleeve Gastrectomy in the Medicare Population

2012

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Recently, we reported on a series of 529 patients who underwent the sleeve gastrectomy (SG) without experiencing a gastrointestinal leak [1]. The results indicate that the procedure is becoming more standardized and thus safer. The Centers for Medicare and Medicaid Services (CMS) approved coverage for the gastric bypass and the adjustable gastric band for individuals who meet the National Institutes of Health criteria for weight loss surgery in 2006. However, CMS has only recently issued a directive regarding Medicare reimbursement for SG. During this consideration, two concerns have arisen: (1) the limited number of SG surgeries reported in the Medicare age group and (2) the potential for a greater risk of complications occurring in the Medicare age group compared to younger adults. We reexamined our retrospective chart review of 766 laparoscopic SG patients and found 15 subjects who fell into the Medicare age group (≥65 years of age). Here, we report on our results.Of the 15 patients, there were 8 females and 7 males. All were white, and none had insurance coverage. The average preoperative weight and BMI were 124.5 kg and 43.3 kg/m 2 , respectively. The average total body weight loss in the Medicare age group was significant, yet more modest than the younger age group (<65 years of age) at 6 months and 1 year (13.5 and 24.1 % versus~20 and~29 %, respectively). All of the subjects in the Medicare age group had one or more comorbidities (primarily hypertension, hypercholesterolemia, and type 2 diabetes), and 11 (73.3 %) had three or more comorbidities. Some patients were able to discontinue their medications for cholesterol (60 %), diabetes (56 %), and hypertension (31 %) postoperatively, and many others were able to do dose reductions. Similarly, a study examining patients over 59 years found that 83 and 58 % of patients resolved their T2D and HTN, respectively [2], and another retrospective review found that elderly patients (>70 years) were able to reduce their medications by at least 50 % postoperatively [3].

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confidence: 81%

Outcomes of the Laparoscopic Sleeve Gastrectomy in the Medicare Population

2012

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“…The mortality reported in other studies ranges from 0.1% to 1.0% and depends on factors such as the profile of the operated patients (age, average BMI, and comorbidities) (6) . Different studies have described mortality rates that were 3 to 10 times higher in patients over 65 years of age than in younger individuals (12) . In the present study, the mortality rate of patients over 65 years of age was 20% (2 deaths among 10 elder patients).…”

Section: Discussionmentioning

confidence: 99%

Early Complications in Bariatric Surgery:

Santo

Pajecki

Riccioppo

et al. 2013

Arq. Gastroenterol.

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-Context -Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control. Method -The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery) were reviewed. Ninety-three (17.2%) patients were male and 445 (82.8%) were female. The ages of the patients ranged from 18 to 70 years (average = 46), and their body mass indices ranged from 34.6 to 77 kg/m 2 . Results -Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5%) patients experienced pulmonary thromboembolism. The mortality rate was 0,55%. Conclusion -The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years.

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“…However, the role of bariatric surgery in patients C60 years old is unclear regarding safety and efficacy [5][6][7][8][9][10] and was the purpose of our study. With the rising incidence of this agegroup combined with the epidemic of obesity, the rate of bariatric operations in patients C60 is increasing.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, however, numerous authors have published studies on the safety and efficacy of bariatric operations in this patient population [2,[6][7][8][9][10].…”

mentioning

confidence: 99%