Impact of Age, Sex and Body Mass Index on Outcomes at Four Years after Gastric Banding

Abstract

Adjustable gastric banding for weight reduction in severely obese persons allows reversible individualized restriction during postoperative follow-up. It is unknown whether preoperative age, sex and BMI might modulate treatment outcome. 404 severely obese patients (79% women; age 42 +/- 0.5 years [mean +/- SEM]; BMI 42.1 +/- 0.2 kg/m2) completed 4-year follow-up after banding. Weight loss, complications, and Bariatric Analysis and Reporting Outcome System (BAROS) scores were recorded prospectively. 4 years after banding, younger (<50 years) women lost more weight than older (50 years) men (28.2 +/- 0.7% vs 19.4+/- 1.6%; P=0.001); older women and younger men lost similar weight. Patients with preoperative BMI >50 lost more weight than patients with BMI <35 (30.5 +/- 2.3% vs 22.8 +/- 2.6%; P=0.03). 22.3% of patients (n=90) had band system-related complications. Compared to women, men had more band leaks (7.0% vs 1.9%; P=0.007), and older men had more band slippages than younger men (8.4% vs 0.0%; P=0.035). Patients with preoperative BMI >50 were less likely than patients with BMI 35-40 or 40-50 to experience gastric complications (10.6%, 18.8%, 23.0%, respectively), but more likely to experience port/tube complications (15.8%, 2.4%, 7.9%, respectively; P<0.055). BAROS scores were different between men and women (P=0.05), and between younger and older people (P=0.001). Women and younger people were more likely than men and older people to score "very good" (P=0.03, P=0.001, respectively). Adjustable gastric banding is an effective intermediate-term treatment for severe obesity. Preoperative age, sex, and BMI are important modulators of outcome and should be considered during preoperative evaluation.