GRAPEVINE, TEX. — Many surgeons are reluctant to perform weight-loss operations in morbidly obese seniors because of concerns that they're at high risk for perioperative morbidity and mortality. But a large new study suggests that's a misperception.
“We found that weight-loss surgery is equally safe and effective in patients over the age of 65 and in younger patients,” Dr. Christopher M. Willkomm reported at the annual meeting of the American Society for Metabolic and Bariatric Surgery.
Dr. Willkomm, a general surgery resident at Baylor University Medical Center, Dallas, reported on 1,474 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass at Baylor during 2005-2008, of whom 100 were aged 65 years or older. The mean age of the seniors was 68, while mean age of the under-65 group was 43 years. Body mass index in the seniors averaged 45 kg/m
All of the patients over age 65 had a preoperative cardiac stress test, bilateral lower-extremity ultrasound, upper GI endoscopy, and pulmonary function tests.
The seniors had a higher operative risk profile. Their 65% prevalence of diabetes was twice that of younger patients, and they had significantly higher rates of hypertension and sleep apnea. Yet their 30-day mortality rate was zero, compared with a 0.14% mortality rate in the younger group. The 30-day readmission rate was 6.0% in the seniors and 7.4% in those under age 65. Operative time in the seniors averaged just 5 minutes more than the 65 minutes in younger patients. Hospital length of stay averaged 2.0 days in the seniors and 1.3 days in younger patients.
Postoperative complication rates were similarly low in both groups. The seniors had a 1% incidence of bleeding requiring transfusion, compared with 1.3% in younger patients, and a 1% rate of wound infections requiring incision and drainage compared with 1.7%, respectively. Similarly, seniors had a 2% incidence of atrial fibrillation, compared with a 0.36% rate of cardiac complications in younger patients, and a 3% incidence of pulmonary complications, compared with 1.3% in younger patients.
At 2 years' follow-up, the seniors had lost an average of 83% of their excess body weight, compared with 78% in the younger group.
Diabetes remission occurred in 63% of the diabetic seniors, who were all off diabetic medications at 1 year of follow-up, as were 69% of diabetic patients under age 65. Of the patients with preoperative hypertension, 23% of seniors were off all antihypertensive medications at follow-up, as were 45% of younger hypertensive patients.
'Weight-loss surgery is equally safe and effective in patients over the age of 65 and in younger patients.'
Source DR. WILLKOMM