WLS not just for the young..

On December 20, 2009, in Uncategorized, by Andrea

Just for the young-at-heart..

From Medscape:

ASMBS 2009: Elderly Obese Patients Benefit From Weight Loss Surgery

Louise Gagnon

June 29, 2009 (Dallas, Texas) — Patients who are older than 65 years fare no differently from their younger counterparts after weight loss surgery, suggesting older age is not a risk factor for complications or mortality in bariatric surgery, a study presented here at the American Society for Metabolic and Bariatric Surgery 26th Annual Meeting shows.

The findings refute previous data that indicated mortality was greater in the elderly after gastric bypass surgery, according to Joseph Kuhn, MD, director of clinical research, Department of Surgery, Baylor University Medical Center, Dallas, Texas.

“A few reports that were released years ago had shown a higher mortality rate occurring with this surgery in patients over 65 [years old],” explained Dr. Kuhn, the study’s principal investigator. “Most of those procedures were open gastric bypass surgeries…only a smattering of them were laparoscop[ic], and most of those were in the learning curve. Modern programs in laparoscopic surgery mean most patients go home the very next day, even with patients who are older than 65.”

Dr. Kuhn and coinvestigators prospectively followed 1753 patients who underwent bariatric surgery between January 2005 and July 2008 at their center and who had at least 6 weeks of postoperative follow-up data.

There were 153 patients who were older than 65 years. They had a less favorable operative risk profile compared with 1600 younger patients who also were followed up. Specifically, older patients had an increased incidence of sleep apnea (46% vs 33%), diabetes mellitus (62% vs 31%), and hypertension (83% vs 57%). The older patients ranged in age from 65 to 77 years and had a mean body mass index of 45 kg/m2, whereas younger patients ranged in age from 18 to 64 years and had a mean body mass index of 47 kg/m2.

Despite their poorer health status, operative outcomes for patients older than 65 years were similar to those for patients younger than 65 years. Operative time was 70 minutes vs 65 minutes, length of stay was 1.6 days vs 1.3 days, and the 30-day readmission rate was 5.2% vs 7.0%.

Furthermore, complication rates did not significantly differ between older and younger patients. Among seniors, there was postoperative bleeding in 0.6% of patients, pulmonary complications in 1.9%, cardiac complications in 1.9%, wound complications in 1.9%, and stricture complications in 1.2%; there were no deaths.

The percentage of excess body weight loss (% EBWL) in patients who had gastric bypass surgery was not significantly different between the older and younger patients at 12 months (60.4% EBWL vs 71.9% EBWL).

Among patients who had undergone gastric banding, there was comparable weight loss in older and younger patients at the 12-month mark (29.9% EBWL vs 35.8% EBWL) and at the 24-month mark (45.3% EBWL vs 33.4% EBWL).

“In contrast to the countless operations that are performed on patients over the age of 65 [years —] like hip replacements, various kinds of cancer surgeries, liver and lung resections — typically as surgeons we don’t hesitate for a second in performing those operations,” said Dr. Kuhn.

“One of the obstacles is the anxiety of [perceived] risk,” said Dr. Kuhn. “The patients are definitely in need of about 100 pounds of weight loss. They are sicker, with more comorbid problems.”

Bruce Wolfe, MD, FACS, a member of the executive council of the American Society for Metabolic and Bariatric Surgery and a professor of surgery at Oregon Health and Science University in Portland, concurred that advancing age had been identified as a risk factor for adverse outcomes following gastric bypass surgery and other bariatric procedures in older analyses.

“The notion that the surgery should be performed infrequently, if at all, in progressively older, severely obese patients has had some basis,” said Dr. Wolfe. “What is important is that we look at the current status of surgery. There have been a number of improvements reported overall in the outcomes of bariatric surgery in various databases that have not found advancing age [to be a risk factor for adverse outcome after the mid-60s].”

The study’s findings show that discouraging the surgery in patients who are not much older than 65 years needs to be reexamined, said Dr. Wolfe, noting that a limitation of the study was that the oldest patient in the study was aged 77 years.

“[Surgery in patients] who are just older than 65 was shown to be safe, but the safety of patients in their late 70s was not addressed,” he said.

Dr. Kuhn has disclosed no relevant financial relationships. Dr. Wolfe is a consultant for Ethicon Endo-Surger Inc and Allergan Inc and is an investigator for EnteroMedics Inc.

American Society for Metabolic and Bariatric Surgery (ASMBS) 26th Annual Meeting: Abstract PL-207. Presented June 25, 2009.

Related Posts with Thumbnails

Leave a Reply