Postoperative Outcomes of Laparoscopic Bariatric Surgery in Older Obese Patients: a Matched Case-Control Study.

Abstract

Laparoscopic bariatric surgery (LBS) in older obese patients remains debated regarding postoperative outcomes. The aim of this case-control study is to evaluate global results of LBS in patients ≥60years (yr) with a matched case control study. All patients ≥60years who benefited from LBS in our center between January 2009 and January 2014 were included in this retrospective study. They were matched (1:2) to patients <40 and 40-59years on BMI, surgical procedure and year, and history of previous LBS. Postoperative complications in the first 90days following LBS, micronutrient and mineral deficiencies, and Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed. Fifty-five patients ≥60year (40 sleeve gastrectomy, 14 one anastomosis gastric bypass, 1 gastric bypass revision) were matched to patients <40year and patients 40-59year (n=55 each). Patients ≥60year presented more obesity-related comorbidities at baseline. Except for bleeding complications (P=0.01), no difference in major complication rate was observed (P=0.43). At 24months, %EWL was lower in older patients compared to others (76.3, 82.2 and 89.7, respectively, P=0.009). Iron and vitamin B12 deficiencies were less prevalent in patients ≥60year After a mean follow-up of 27months, BAROS score (filled in by 82% of patients) was lower in patients ≥60years (P=0.01). Despite less weight loss, postoperative complications rate, and lower BAROS results, LBS keeps an acceptable benefit-risk balance in selected older patients and should not be rejected on the sole argument of age. Additional studies are needed to assess the long-term benefits of LBS in older patients.