Laparoscopic Sleeve Gastrectomy in Patients over 59 Years: Early Recovery and 12-Month Follow-Up

Abstract

Background Bariatric surgery has shown to be safe for patients over 60 years with good results especially considering resolving of comorbidities. Sleeve gastrectomy is considered to be safer than gastric bypass (GBP) and more effective than gastric banding with less adverse symptoms. Weight loss may be more modest than after GBP, but the effect on vitamins may also be milder. Methods Since 2007, we collected prospectively 12-month follow-up data from 55 sleeve gastrectomy patients of whom 12 were over 59 years of age. Vitamin and calcium supplements were used postoperatively. The recovery from the operation was recorded during hospital stay, at 1-and 12-month follow-up visits using a standard protocol including laboratory tests. The results between patients over and under 59 years were compared. Results The preoperative weight and weight loss were comparable between the groups. Operation time was shorter and hospital stay was longer for older patients, p= ns. There was no operative mortality. Early major complications were seen more often in the older age group, 42% vs 9% (p=0.02), but late complications were more common in younger patients, 17% vs 44%, p=ns. Early complications were mostly bleedings, which did not lengthen the hospital stay, neither were re-operations nor endoscopic procedures needed. Excess weight loss and resolving of comorbidities after 12 months was comparable between the groups. However, vitamin deficiencies and hypoalbuminemia were more common in the older age group, 42% and 23% for vitamins and 44% and 29% for proteins, p =ns. The older patients had more adverse effects related to surgery, 25% vs 9%, and younger had more adverse psychiatric effects, p=ns. Conclusions Sleeve gastrectomy is effective and safe for older bariatric patients. Weight loss is comparable to younger patients and enough to resolve the comorbidities in most of the patients. With standardized nutritional supplementation, the older patients had more often vitamin deficiencies and hypoalbuminemia. Although operative treatment of older bariatric patients is safe, their postoperative care is demanding considering vitamins and protein.

Does Age Influence Bariatric Surgery Outcomes?

“…11,17,18 However, recent studies have shown that bariatric surgery in older patients is as safe and effective for weight loss as for younger patients. [12][13][14][15]19 The present study showed no significant differences in %EWL in patients across age groups.…”

“…Some studies have shown that older patients achieve weight loss comparable to that of younger patients. [11][12][13][14][15] Due to limited data, weight loss surgery has been underutilized among older patients due to the perceived risk of complications and poor success in postsurgical results. 16 Due to the inconsistencies in prior studies, this study evaluated presurgical comorbidities, perioperative and postoperative complications, and postsurgical outcomes (defined as percentage excess weight loss [%EWL]) of minimally invasive bariatric surgery in patients aged 55 years and older to determine if age should be used as a selection criteria for bariatric surgery.…”

Outcomes of the Laparoscopic Sleeve Gastrectomy in the Medicare Population

“…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.…”

“…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].…”

Is sleeve gastrectomy still contraindicated for patients aged≥60 years? A case-matched study with 24 months of follow-up

“…The short-term mortality rate was 0%. In a prospective analysis of 55 patients undergoing SG (43 were aged o58 years and 12 were aged 459 years), Leivonen et al [31] showed that older patients had a shorter operating time and a longer hospital stay (P 4 .05). Major, early-onset complications were more frequent in the older age group (42%, versus 9% in the younger group; P ¼ .02) but late complications were less common (17%, versus 44% in the younger group; P 4 .05).…”