Bariatric and metabolic outcomes in the super-obese elderly

Abstract

BackgroundNumerous reports address bariatric outcomes in super-obese or elderly patients, but data addressing this high-risk combination is lacking. ObjectiveThe objective of this study was to assess outcomes of bariatric surgery in the super-obese elderly. SettingAcademic institution, United States. MethodsAll primary bariatric cases performed on patients aged 65 years or older with a body mass index (BMI)≥50 kg/m2 were retrospectively analyzed. Surgical approaches included laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB). ResultsThirty patients (26 female, 4 male) with a mean age of 67.1±2.7 years and BMI of 55.9±3.9 kg/m2, who had LRYGB (n = 16), LSG (n = 6), or LAGB (n = 8), were identified. There were no deaths, conversions, or intraoperative complications. Three patients were lost to follow-up after the 3-month visit. The early (<30 d) major morbidity rate was 10.0%. At a median follow-up of 37 (range, 6–95) months, the cohort had a mean BMI of 42.3±6.7 kg/m2, which corresponded to a mean percent excess weight loss of 44.5%±20.5% and mean percent total weight loss of 24.4%±12.2%. The most percent excess weight loss was achieved after LRYGB (54.1%±19.4%), followed by LSG (48.3%±10.2%) and then LAGB (26.2%±14.4%). Diabetic medication reduction in number and/or dosage was observed in 40% (6/15) patients, and 33% (5/15) of patients were completely off antidiabetic agents. ConclusionsAlthough further research is needed, the present data suggest that successful weight loss and metabolic improvement can be achieved safely in the high-risk population of super-obese elderly.