Our publication on the potential benefits of bariatric surgery in obese older people, work that followed on from our MID-Frail and Frailomic studies, was published in the journal Cardiovascular Endocrinology today [1]. The aim of the Niche team was to determine whether older (≥65 years) obese people would benefit from bariatric surgery, considering prevalence of multiple comorbidities and frailty in this group.
This was literature-based investigation where a PubMed search was carried out seeking studies on the use of bariatric surgery in the target population between the dates 1980 to present (August 2014). Two hundred and forty-four citations were obtained; 182 of these publications were selected for manual checking and 10 studies were identified as containing useable data on this patient cohort. Published data were available for efficacy in 641 patients. The data indicated substantial improvements in diabetes (76%), hypertension (68%) and sleep apnoea (67%) following bariatric surgery. Laparoscopic adjustable gastric banding (n=456) was the most frequently reported procedure. Similar findings but with greater weight loss and fewer complications were found in the small numbers of patients undergoing other procedures. Data from four large registry studies (n=6837) showed mortality and complications associated with bariatric surgery to be increased in older people compared with younger especially in those undergoing gastric bypass surgery. The elderly had longer hospital stays, and patients with cardiac, pulmonary or renal comorbidities generally had a worse prognosis.
The study concludes that bariatric surgery in older people is not only effective in reducing complications of obesity but is also associated with increased rates of complications compared with those seen in younger patients. The few reported studies in the elderly are retrospective, generally small, primarily describe findings of laparoscopic adjustable gastric banding as the surgical intervention option and lack long-term follow-up. More trials and registry data, especially for sleeve gastrectomy and gastric bypass, are required to better address the utility of bariatric surgery in the elderly and to define long-term clinical outcomes.
References
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