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Barajas-Gamboa JS, Serra FE, Romero-Velez G, Dang JT, Del Gobbo GD, Abdallah M, Abril C, Raza J, Guerron AD, Corcelles R, Kroh M, Rodriguez J, Pantoja JP. Bariatric Surgical Outcomes in the Elderly: A Comparison Study Between Primary and Revisional Procedures in the United Arab Emirates. Obes Surg 2024; 34:2515-2522. [PMID: 38819724 DOI: 10.1007/s11695-024-07304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Data reported on comparing primary and revisional procedures in the elderly is still limited. The aim of this study was to compare the efficacy and safety between primary and revisional bariatric surgery in a cohort of older patients. MATERIALS AND METHODS All patients ≥ 60 years old were divided into two cohorts, primary surgery cohort (PSC) and revisional surgery cohort (RSC). Baseline and perioperative outcomes were analyzed. RESULTS Fifty-eight patients were included (34 PSC and 24 RSC) in the study. Forty-two (25 PSC and 17 RSC) 72.4% were female. The mean age was 64 (± 3.3 years) in the PSC and 65 (± 4.2 years) in the RSC, the median initial BMI was 46.7 and 47.4 kg/m2 (p < 0.848), respectively. The mean hospital stay was (3 PSC vs. 5 RSC, p < 0.022) days. Readmissions occurred in (1 PSC vs. 3 RSC, p = 0.158) patients within 30 days of discharge. Postoperative major complications included (1 PSC vs. 5 RSC, p < 0.0278) patients. Reoperations were reported in (0 PSC vs. 3 RSC, p < 0.034) patients. Patients who underwent surgery for weight management, the initial mean BMI was (46.7 PSC vs. 47.4 RSC kg/m2, p = 0.848). At 12-months post-procedure, the mean BMI was (34.3 PSC vs. 37.7 RSC kg/m2, p = 0.372) and (23.7 PSC vs. 19.1 RSC, p = 0.231) %TBWL. The mean overall follow-up was (12.4 PSC vs. 27.5 RSC, p < 0.004) months, and one unrelated death (cancer) was reported in the RSC. CONCLUSION PSC and RSC are effective in the elderly, however postoperative complications occurred more often in the RSC group.
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Affiliation(s)
- Juan S Barajas-Gamboa
- Digestive Disease Institute, Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Gustavo Romero-Velez
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Jerry T Dang
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Gabriel Diaz Del Gobbo
- Digestive Disease Institute, Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Mohammed Abdallah
- Digestive Disease Institute, Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Carlos Abril
- Digestive Disease Institute, Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Javed Raza
- Digestive Disease Institute, Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Alfredo D Guerron
- Digestive Disease Institute, Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ricard Corcelles
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Matthew Kroh
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - John Rodriguez
- Digestive Disease Institute, Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Juan Pablo Pantoja
- Digestive Disease Institute, Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
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Belluzzi A, Hage K, Abi Mosleh K, Mundi MS, Abu Dayyeh B, Ghanem OM. Long-Term Safety and Efficacy of Bariatric Surgery in Septuagenarians. Obes Surg 2023; 33:3778-3785. [PMID: 37840092 DOI: 10.1007/s11695-023-06882-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) has been shown to be safe and effective in the elderly population. Unfortunately, utilization of MBS in patients aged 70 years or older remains low, as MBS was just recently endorsed by the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity (IFSO) for septuagenarians. MATERIALS AND METHODS We performed a single-center retrospective cohort study of 103 patients aged ≥ 70 years who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from January 2008 until March 2023. The data analyzed included patient demographics, post-operative complications, resolution of obesity-related comorbidities, and weight loss. RESULTS A total of 103 patients (71% female; age 72.1 ± 2.5 years; BMI 43.7 ± 6.8 kg/m2) were included. Sixty-two patients (60.2%) underwent RYGB while the remaining 41 underwent SG (39.8%), with a mean follow-up of 4.7 ± 3.7 years. There was no MBS-related mortality. All-cause mortality rates were 7.3% for the SG group after a mean period of 4.5 ± 3.9 years compared to 8.1% for the RYGB cohort after 7.7 ± 3.5 years (p = 0.601). RYGB was reported to have a higher rate of early and late complications when compared to LSG (p = 0.083 and p = 0.274). T2DM (p = 0.011) and OSA (p = 0.019) resolved significantly after RYGB. CONCLUSION Our study demonstrates that bariatric surgery is safe and effective in patients aged 70 years and older. Bariatric surgery should not be denied to this group of patients based on chronological age alone. Further studies are required to support these findings.
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Affiliation(s)
- Amanda Belluzzi
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Padova University Hospital, Bariatric Unit, Week Surgery, 35128, Padua, Italy
| | - Karl Hage
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kamal Abi Mosleh
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Manpreet S Mundi
- Department of Internal Medicine, Division of Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Barham Abu Dayyeh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Chockalingam A, Natarajan P, Dorairajan S, Khan U. Early Recognition of Overweight Hyperglycaemia May Improve Clinical Outcomes in Type 2 Diabetes. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:33-37. [PMID: 37313244 PMCID: PMC10258620 DOI: 10.17925/ee.2023.19.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/20/2023] [Indexed: 06/15/2023]
Abstract
Diabetes is the ninth leading cause of death, directly accounting for 1.5 million deaths annually worldwide. Despite several breakthrough discoveries, little progress has been made in type 2 diabetes outcomes over the past 100 years. Younger age (below 60 years), a diet high in calories and processed food, and severe obesity (body mass index >35 kg/m2) may identify reversible beta cell dysfunction. Much of the clinical presentation pertains to flooding the body's adaptive limits with overnutrition. Recognizing this as a global societal trend brought about by lifestyle changes, sedentary work, mental stress and unlimited access to calorie-dense foods is crucial. Insulin resistance and genetic abnormalities cannot account for the dramatic increase in diabetes, from only 1% five decades ago to nearly 10% today. Obesity - and not insulin resistance - is at the core of the problem. As well as hyperglycaemia, end-organ damage can also be reversed with diet and weight loss in many affected individuals. We present the evolution of our understanding and compelling reasons to reframe diabetes in the severely obese to what it really is - overweight hyperglycaemia. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles. The objective of this review is to better understand global trends and the potential to improve outcomes by reframing the diabetes narrative towards remission. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles.
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Affiliation(s)
- Anand Chockalingam
- Division of Cardiovascular Medicine, University of Missouri, Columbia, MO, USA
- Cardiology Section, Harry S Truman VA Medical Center, Columbia, MO, USA
| | - Pandiyan Natarajan
- Nova IVF Fertility, Chettinad Super Speciality Hospital (Retired), Chennai, India
| | - Smrita Dorairajan
- Nephrology Section, Harry S Truman VA Medical Center, Columbia, MO, USA
| | - Uzma Khan
- Division of Endocrinology, University of Missouri, Columbia, MO, USA
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Singhal R, Omar I, Madhok B, Rajeev Y, Graham Y, Tahrani AA, Ludwig C, Wiggins T, Mahawar K. Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic. Obes Surg 2022; 32:1-13. [PMID: 35513762 PMCID: PMC9071248 DOI: 10.1007/s11695-022-06067-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022]
Abstract
Background Age ≥ 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort. Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups — patients ≥ 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality. Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 ± 2.5 years, 119.5 ± 24.5 kg, and 43 ± 7 in Group I and 39.8 ± 11.3 years, 117.7±20.4 kg, and 43.7 ± 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I (11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups. Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those ≥ 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups. Graphical abstract ![]()
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Affiliation(s)
- Rishi Singhal
- Upper GI unit, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Bordesley Green East, Birmingham, West Midlands, B9 5SS, UK.
- Healthier Weight, Birmingham, UK.
| | - Islam Omar
- General Surgery Department, Wirral University Teaching Hospital NHS Foundation Trust, North West, Wirral, UK
| | - Brijesh Madhok
- Upper GI unit, University Hospital of Derby and Burton NHS Foundation Trust, East Midlands, Derby, UK
| | - Yashasvi Rajeev
- Pediatric Accidents and Emergencies Department, London Northwest University Healthcare NHS Trust, London, UK
| | - Yitka Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, North East, Sunderland, UK
- Faculdad de Pyscologia, Universidad Anahuac, Anahuac, Naucalpan de Juárez, Mexico
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes, and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Christian Ludwig
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Tom Wiggins
- Upper GI unit, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Bordesley Green East, Birmingham, West Midlands, B9 5SS, UK
| | - Kamal Mahawar
- Faculty of Health Sciences and Wellbeing, University of Sunderland, North East, Sunderland, UK
- Bariatric Unit, South Tyneside and Sunderland NHS Foundation Trust, North East, Sunderland, UK
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Athanasiadis DI, Hernandez E, Dirks RC, Stefanidis D, Banerjee A. Postoperative 4-Year Outcomes in Septuagenarians Following Bariatric Surgery. Obes Surg 2021; 31:5127-5131. [PMID: 34476727 DOI: 10.1007/s11695-021-05694-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bariatric surgery is the most effective treatment for obesity; however, its utilization in older patients remains low. There is a dearth of literature on long-term effectiveness and safety of bariatric surgery in septuagenarian patients. The aim of this study was to compare the short- and long-term outcomes of bariatric surgery in this population. METHODS Patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) at our institution between 2011 and 2015 were included. Patients were divided into two age groups: < 70 and ≥ 70 years. Outcomes included postoperative hospital length of stay (LOS), 30-day complications, up to 4-year complications, 90-day mortality, comorbidity resolution, and 4-year weight loss (BMI change-ΔΒΜΙ). The groups were also compared using multivariable analyses adjusting for potential confounders (gender, preoperative BMI, and type of procedure). RESULTS Twenty-nine septuagenarians who underwent 21 LRYGB (72.4%) and 8 LSG (27.6%) were compared to 1016 patients aged < 70 years operated on during the same time period. Additionally, following the multivariable analyses, the septuagenarians had higher LOS (3 vs 2.3 days, p = 0.01), 4-year complications (38% vs 23%, p = 0.012), and less comorbidities' resolution but similar 4-year ΔBMI (- 8.6 vs - 10, p = 0.421), and 30-day complications (10% vs 6%, p = 0.316). CONCLUSION Bariatric surgery in carefully selected septuagenarians can be accomplished with acceptable safety and comparable postoperative weight loss at 4 years. Surgeons may consider broadening their selection criteria to include this patient subgroup but may allow the patients to reap its benefits if offered earlier in life.
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Affiliation(s)
| | - Edward Hernandez
- Department of Surgery, Indiana University School of Medicine Indiana, Indianapolis, IN, USA
| | - Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine Indiana, Indianapolis, IN, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine Indiana, Indianapolis, IN, USA
- Section of Minimally Invasive and Bariatric Surgery, Indiana University Health North Hospital, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA
| | - Ambar Banerjee
- Department of Surgery, Indiana University School of Medicine Indiana, Indianapolis, IN, USA.
- Section of Minimally Invasive and Bariatric Surgery, Indiana University Health North Hospital, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA.
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Buch A, Marcus Y, Shefer G, Zimmet P, Stern N. Approach to Obesity in the Older Population. J Clin Endocrinol Metab 2021; 106:2788-2805. [PMID: 34406394 DOI: 10.1210/clinem/dgab359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Indexed: 12/14/2022]
Abstract
Until recently, weight loss in older obese people was feared because of ensuing muscle loss and frailty. Facing overall increasing longevity, high rates of obesity in older individuals (age ≥ 65 years) and a growing recognition of the health and functional cost of the number of obesity years, abetted by evidence that intentional weight loss in older obese people is safe, this approach is gradually, but not unanimously, being replaced by more active principles. Lifestyle interventions that include reduced but sufficient energy intake, age-adequate protein and micronutrient intake, coupled with aerobic and resistance exercise tailored to personal limitations, can induce weight loss with improvement in frailty indices. Sustained weight loss at this age can prevent or ameliorate diabetes. More active steps are controversial. The use of weight loss medications, particularly glucagon-like peptide-1 analogs (liraglutide as the first example), provides an additional treatment tier. Its safety and cardiovascular health benefits have been convincingly shown in older obese patients with type 2 diabetes mellitus. In our opinion, this option should not be denied to obese individuals with prediabetes or other obesity-related comorbidities based on age. Finally, many reports now provide evidence that bariatric surgery can be safely performed in older people as the last treatment tier. Risk-benefit issues should be considered with extreme care and disclosed to candidates. The selection process requires good presurgical functional status, individualized consideration of the sequels of obesity, and reliance on centers that are highly experienced in the surgical procedure as well as short-term and long-term subsequent comprehensive care and support.
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Affiliation(s)
- Assaf Buch
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Yonit Marcus
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gabi Shefer
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Paul Zimmet
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia
| | - Naftali Stern
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Mantziari S, Dayer A, Duvoisin C, Demartines N, Allemann P, Calmes JM, Favre L, Fournier P, Suter M. Long-Term Weight Loss, Metabolic Outcomes, and Quality of Life at 10 Years After Roux-en-Y Gastric Bypass Are Independent of Patients' Age at Baseline. Obes Surg 2021; 30:1181-1188. [PMID: 32008256 DOI: 10.1007/s11695-019-04181-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Conflicting data have been published for bariatric surgery in older patients, with no long-term large-scale studies available. Our aim was to provide long-term (> 10 years) results on weight loss, metabolic outcomes, and quality of life in a large homogenous series of Roux-en-Y gastric bypass (RYGB) patients, according to age at baseline. PATIENTS AND METHODS All consecutive patients who underwent primary RYGB between 1999 and 2007, and therefore eligible for 10-year follow-up, were retrospectively analyzed. According to their age at baseline, they were divided into three groups: A (< 40 years), B (40-54 years), and C (≥ 55 years). Categorical variables were compared with the χ2 test and continuous variables with ANOVA. RESULTS Our series consisted of 820 patients, with a 10-year follow-up of 80.6%. Although group C (11% of all patients) had significantly more comorbidities at baseline, there was no difference in postoperative morbidity and mortality between groups. Weight loss was significantly less for group C patients up to the 7th postoperative year, but no difference remained thereafter. 10-year %total weight loss was 32.2, 32.9, and 32.3 respectively in groups A, B, and C. After 10 years, glycemic control and lipid profile improved similarly, rates of partial or complete remission of diabetes and hypertension were identical, and quality of life presented a significant improvement for all patients with no inter-group difference. CONCLUSION Our results suggest similar short- and long-term outcomes after RYGB for patients ≥ 55 years compared to younger ones; the relative benefit might even be higher for older patients, given their increased comorbidity at baseline.
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Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Anna Dayer
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.,Department of Surgery, Riviera-Chablais Hospital, Aigle-Monthey, Switzerland
| | - Céline Duvoisin
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pierre Allemann
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jean-Marie Calmes
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Lucie Favre
- Department of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pierre Fournier
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Michel Suter
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland. .,Department of Surgery, Riviera-Chablais Hospital, Aigle-Monthey, Switzerland.
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Mendonça F, Silva MM, Salazar D, Ferreira MJ, Pedro J, Guerreiro V, Viana S, Neves JS, Belo S, Varela A, Freitas P, Carvalho D. Bariatric Surgery Impact on Cardiovascular Risk Factors: Is Age a Factor to Consider? Obes Facts 2021; 14:72-77. [PMID: 33321490 PMCID: PMC7983533 DOI: 10.1159/000511737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite the abundance of data addressing the influence of patient's age on surgery-related complications, its impact on cardiometabolic outcomes following bariatric surgery has been overlooked. METHODS Retrospective unicentric study of 1,728 obese patients who underwent bariatric surgery between January 2010 and June 2015. Patients were divided in 3 age groups, according to their age at surgery: ˂40 (n = 751), 40-59 (n = 879), and ≥60 years (n = 98). Parameters with cardiometabolic impact, such as body anthropometric measures, lipid profile, and glycemic status, before and 24 months after surgery, were compared between these groups. A multiple linear regression was performed, adjusting differences between groups for sex, surgery type, and body mass index variation. RESULTS The group ˂40 years presented more weight loss (-35.4 ± 9.0 kg, p ˂ 0.001), greater BMI reduction (-15.8 ± 6.1 kg/m2, p ˂ 0.001), and larger changes in waist (-34 ± 13.8 cm, p ˂ 0.001) and hip circumferences (-28.7 ± 11.9 cm, p ˂ 0.05). The group of ≥60 years presented the heaviest reduction in fasting glucose (-17.7 ± 32.8 mg/dL, p ˂ 0.001) and HbA1c (0.7 ± 1.0, p ˂ 0.001), and also had a tendency to have the biggest changes in systolic blood pressure (-14.7 ± 18.7 mm Hg, p = 0.071). CONCLUSION Patients with ≥60 years benefit the most from bariatric surgery regarding cardiometabolic parameters, presenting heavier reductions in fasting glucose, as well as HbA1c and a tendency towards a higher decrease in systolic blood pressure. No clinically significant differences in lipid profile were observed between groups.
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Affiliation(s)
- Fernando Mendonça
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal,
- Faculty of Medicine, Universidade do Porto, Porto, Portugal,
| | - Maria Manuel Silva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Maria João Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Sara Viana
- Unidade Local de Saúde do Norte Alentejano EPE, Évora, Portugal
| | - Joao Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Sandra Belo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Ana Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
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Comment on: Bariatric surgery in the elderly: a randomized prospective study comparing safety of sleeve gastrectomy and Roux-en-Y gastric bypass (BASE Trial). Surg Obes Relat Dis 2020; 16:1440-1441. [PMID: 32763106 DOI: 10.1016/j.soard.2020.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/22/2022]
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10
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Chokesuwattanaskul R, Thongprayoon C, Bathini T, Sharma K, Watthanasuntorn K, Lertjitbanjong P, Pachariyanon P, Prechawat S, Mao MA, Torres‐Ortiz A, Cheungpasitporn W. Incident atrial fibrillation in patients undergoing bariatric surgery: a systematic review and meta‐analysis. Intern Med J 2020; 50:810-817. [DOI: 10.1111/imj.14436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Ronpichai Chokesuwattanaskul
- Division of Cardiology, Department of MedicineFaculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok Thailand
| | | | - Tarun Bathini
- Department of Internal MedicineUniversity of Arizona Tucson Arizona USA
| | - Konika Sharma
- Department of Internal MedicineBassett Medical Center Cooperstown New York USA
| | | | | | - Pavida Pachariyanon
- Department of Internal MedicineTexas Tech University Health Sciences Center Lubbock Texas USA
| | - Somchai Prechawat
- Division of Cardiology, Department of MedicineFaculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok Thailand
| | - Michael A. Mao
- Department of Internal MedicineMayo Clinic Jacksonville Florida USA
| | - Aldo Torres‐Ortiz
- Division of Nephrology, Department of MedicineUniversity of Mississippi Medical Center Jackson Mississippi USA
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of MedicineUniversity of Mississippi Medical Center Jackson Mississippi USA
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11
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Moreno Gijón M, Díaz Vico T, Rodicio Miravalles JL, López-Negrete Cueto E, Suárez Sánchez A, Amoza Pais S, Sanz Navarro S, Valdés Arias C, Turienzo Santos EO, Sanz Álvarez LM. Prospective Analysis Regarding Health-Related Quality of Life (HR-QOL) between Morbid Obese Patients Following Bariatric Surgery Versus on a Waiting List. Obes Surg 2020; 30:3054-3063. [PMID: 32388708 DOI: 10.1007/s11695-020-04652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Major impairment of health-related quality of life (HRQoL) is one of the main reasons why obese patients request surgical treatment. OBJECTIVE To prospectively analyze the impact of HRQoL between obese patients who underwent surgery and those who were wait-listed. METHODS Between April 2017 and March 2018, 70 surgical and 69 wait-listed patients were interviewed twice, at baseline and at the 12-month follow-up. Quality of life was measured by the SF-12v2 and the Impact of Weight on Quality of Life-Lite (IWQoL-Lite) questionnaires. Sociodemographic-, clinical-, and surgical-related variables were collected. RESULTS One hundred thirty-nine patients were analyzed, showing similar baseline characteristics but differences in HRQoL. Performing more qualified work improved scores on some aspects of the SF-12 survey. In contrast, women scored worse on the self-esteem domain, and men scored worse on the mental health domain. By group, at the 12-month follow-up, statistically significant differences were found among all aspects of the questionnaires between both groups (P < 0.001) and between baseline and postoperative 12-month follow-up in the surgical group (P < 0.001). Furthermore, scores were lower in all domains in the evolution of wait-listed patients, with statistically significant differences among the Bodily Pain, Emotional Role, Mental Health, and Mental Component Summary Domains (P < 0.05). CONCLUSION HRQoL is a multimodal concept that allows the identification of factors impacting obese patients' quality of life. It promotes the benefit of surgery against waiting list delays, which can take up to 4 years in our hospital. Therefore, HRQoL is an important pillar to justify more resources for reducing unacceptable surgical delays.
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Affiliation(s)
- María Moreno Gijón
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Calle de la aldea de Cerdeño esquina con Av. del Hospital Universitario, 33011, Oviedo, Asturias, Spain.
| | - Tamara Díaz Vico
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Calle de la aldea de Cerdeño esquina con Av. del Hospital Universitario, 33011, Oviedo, Asturias, Spain
| | - José Luis Rodicio Miravalles
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Calle de la aldea de Cerdeño esquina con Av. del Hospital Universitario, 33011, Oviedo, Asturias, Spain
| | - Emilio López-Negrete Cueto
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Calle de la aldea de Cerdeño esquina con Av. del Hospital Universitario, 33011, Oviedo, Asturias, Spain
| | - Aida Suárez Sánchez
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Calle de la aldea de Cerdeño esquina con Av. del Hospital Universitario, 33011, Oviedo, Asturias, Spain
| | - Sonia Amoza Pais
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Calle de la aldea de Cerdeño esquina con Av. del Hospital Universitario, 33011, Oviedo, Asturias, Spain
| | - Sandra Sanz Navarro
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Calle de la aldea de Cerdeño esquina con Av. del Hospital Universitario, 33011, Oviedo, Asturias, Spain
| | - Covadonga Valdés Arias
- Foundation for Biosanitary Research and Innovation in the Principality of Asturias, Oviedo, Spain
| | - Estrella O Turienzo Santos
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Calle de la aldea de Cerdeño esquina con Av. del Hospital Universitario, 33011, Oviedo, Asturias, Spain
| | - Lourdes M Sanz Álvarez
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Calle de la aldea de Cerdeño esquina con Av. del Hospital Universitario, 33011, Oviedo, Asturias, Spain
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12
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Bartosiak K, Różańska-Walędziak A, Walędziak M, Kowalewski P, Paśnik K, Janik MR. The Safety and Benefits of Laparoscopic Sleeve Gastrectomy in Elderly Patients: a Case-Control Study. Obes Surg 2020; 29:2233-2237. [PMID: 31020498 DOI: 10.1007/s11695-019-03830-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The advancement of minimal invasive techniques pushed the age limit for patients qualified for bariatric surgery. AIM The aim of the study was to evaluate the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in a cohort of patients aged 60 years or more, compared with a group of matched controls below 40 years old. METHODS The medical records of 856 patients were analyzed. Patients aged 60 years or older were identified as cases. Those below 40 years were identified as the controls. Cases were closely matched (1:1) with the controls by body mass index (BMI) (± 1 kg/m2) and presence or absence of hypertension and diabetes mellitus. RESULTS A 34 matched pairs were included in the study. There was no significant difference in the median operation length. No conversion from laparoscopic to open surgery was needed. The hospital length of stay was significantly longer in the study group (4.5 ± 1.9 vs 3.9 ± 1.5 days, p = 0.047). The complication, 30-day reoperation, and 30-day reoperation rates were comparable in both groups. There were no 30-day readmissions nor 30-day mortality. ΔBMI after 12 months was significantly lower in the study group (13.56 ± 6.05 vs 10.3 ± 4.89, p = 0.008) as well as %EBMIL (50.71 ± 25.94 vs 64.20 ± 23.29, p = 0.015). CONCLUSIONS The study suggests that LSG is a safe method of bariatric treatment in patients aged above 60 years. Even though weight loss may be lesser than in younger patients, it can still be considered satisfactory.
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Affiliation(s)
- Katarzyna Bartosiak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141, Warsaw, Poland
| | - Anna Różańska-Walędziak
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141, Warsaw, Poland
| | - Piotr Kowalewski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141, Warsaw, Poland
| | - Krzysztof Paśnik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141, Warsaw, Poland
| | - Michał R Janik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141, Warsaw, Poland.
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Is There an Upper Age Limit for Bariatric Surgery? Laparoscopic Gastric Bypass Outcomes in Septuagenarians. Obes Surg 2020; 30:2482-2486. [DOI: 10.1007/s11695-020-04532-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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14
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Smith ME, Bacal D, Bonham AJ, Varban OA, Carlin AM, Ghaferi AA, Finks JF. Perioperative and 1-year outcomes of bariatric surgery in septuagenarians: implications for patient selection. Surg Obes Relat Dis 2019; 15:1805-1811. [PMID: 31530451 DOI: 10.1016/j.soard.2019.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/12/2019] [Accepted: 08/03/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although bariatric surgery is an effective treatment for obesity, utilization of bariatric procedures in older adults remains low. Previous work reported higher morbidity in older patients undergoing bariatric surgery. However, the generalizability of these data to contemporary septuagenarians is unclear. OBJECTIVES We sought to evaluate differences in 30-day outcomes, 1-year weight loss, and co-morbidity remission after bariatric surgery among 3 age groups as follows: <45 years, 45-69 years, and ≥70 years. SETTING Statewide quality improvement collaborative. METHODS Using a large quality improvement collaborative, we identified patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 2006 and 2018. We used multivariable logistic regression models to evaluate the association between age cohorts and 30-day outcomes, 1-year weight loss, and co-morbidity remission. RESULTS We identified 641 septuagenarians who underwent SG (68.5%) or RYGB (31.5%). Compared with 45-69 year olds, septuagenarians had higher rates of hemorrhage (5.1% versus 3.1%; P = .045) after RYGB and higher rates of leak/perforation (.9% versus .3%; P = .044) after SG. Compared with younger patients, septuagenarians lost less of their excess weight, losing 64.8% after RYGB and 53.8% after SG. Remission rates for diabetes and obstructive sleep were similar for patients aged ≥70 years and 45-69 years. CONCLUSIONS Bariatric surgery in septuagenarians results in substantial weight loss and co-morbidity remission with an acceptable safety profile. Surgeons with self-imposed age limits should consider broadening their selection criteria to include patients ≥70 years old.
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Affiliation(s)
- Margaret E Smith
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Daniel Bacal
- Department of Surgery, Beaumont Hospital Dearborn, Dearborn, Michigan
| | - Aaron J Bonham
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
| | - Oliver A Varban
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Amir A Ghaferi
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jonathan F Finks
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
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15
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Goldberg I, Yang J, Nie L, Bates AT, Docimo S, Pryor AD, Cohn T, Spaniolas K. Safety of bariatric surgery in patients older than 65 years. Surg Obes Relat Dis 2019; 15:1380-1387. [PMID: 31248793 DOI: 10.1016/j.soard.2019.05.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/28/2019] [Accepted: 05/07/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The increase in life expectancy along with the obesity epidemic has led to an increase in the number of older patients undergoing bariatric surgery. There is conflicting evidence regarding the safety of performing bariatric procedures on older patients. OBJECTIVE The purpose of this study was to compare the safety of laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for older patients (>65 yr). SETTING Nationwide analysis of accredited centers. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 to 2017 database was used to identify nonrevisional laparoscopic RYGB and SG procedures. Comparisons were made based on patient age. Clinical outcomes included postoperative events and mortality. RESULTS There was a total 13,422 and 5395 matched pairs for SG and RYGB in comparing patients aged 18 years to those aged 65 and >65 years, respectively, and 5395 matched RYGB and SG procedures performed in patients >65 years. The complication rate was higher in older patients undergoing RYGB compared with SG (risk difference = 2.39%, 95% confidence interval: 1.57%-3.21%, P < .0001). When comparing older to younger patients, the older group had a higher complication rate for SG but not for RYGB (SG: risk difference = 1.01%, 95% confidence interval: .59%-1.43%, P < .0001, RYGB: risk difference = .59%, 95% confidence interval: -.29% to 1.47%, P = .2003). CONCLUSIONS Overall complication rates of bariatric surgery are low in patients >65 years. SG appears to have a favorable safety profile in this patient population compared with RYGB. The overall complication rate for RYGB is not significantly different between the older and younger groups.
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Affiliation(s)
- Iliya Goldberg
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York.
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Lizhou Nie
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York
| | - Andrew T Bates
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Salvatore Docimo
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Aurora D Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Tyler Cohn
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
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16
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Tangelloju S, Little BB, Esterhay RJ, Brock G, LaJoie AS. Type 2 Diabetes Mellitus (T2DM) "Remission" in Non-bariatric Patients 65 Years and Older. Front Public Health 2019; 7:82. [PMID: 31032243 PMCID: PMC6473045 DOI: 10.3389/fpubh.2019.00082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/20/2019] [Indexed: 12/14/2022] Open
Abstract
Objective: To analyze the factors associated with type 2 diabetes mellitus (T2DM) “remission” in non-bariatric Medicare patients 65 years and older. Research Design and Methods: A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if the individual had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in “remission” if they had no T2DM related claims for more than 12 months continuously. This is different from the standard American Diabetes Association (ADA) definition of remission which includes HbA1c values and hence is represented in quotation (as “remission”). 10,059 T2DM individuals were evaluated over a period of 8 years from 2008 to 2015. Cox proportional hazards was used to identify significant variables associated with T2DM “remission.” Results: 4.97% of patients studied met the definition of T2DM “remission” in the study cohort. After adjusting for covariates this study found a number of variables associated with T2DM “remission” that were not previously reported: no statin use; low diabetes complications severity index score; no hypertension; no neuropathy; no retinopathy; race (non-white and non-African American); presence of other chronic ischemic heart disease (IHD) and females (p < 0.05). Conclusion: T2DM “remission” in Medicare patients 65 years and older is observed in a community setting in a small proportion of non-bariatric patients.
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Affiliation(s)
- Srikanth Tangelloju
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States
| | - Bert B Little
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States
| | - Robert J Esterhay
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States
| | - Guy Brock
- Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - A Scott LaJoie
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States
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17
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Vinan-Vega M, Diaz Vico T, Elli EF. Bariatric Surgery in the Elderly Patient: Safety and Short-time Outcome. A Case Match Analysis. Obes Surg 2018; 29:1007-1011. [PMID: 30536201 DOI: 10.1007/s11695-018-03633-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Indications and outcomes of bariatric surgery in the elderly remain controversial. We aimed to evaluate and compare safety and early outcomes of bariatric procedures in this age group. STUDY DESIGN We performed a retrospective case-control study of Mayo Clinic bariatric surgery patients from January 1, 2016, to January 31, 2018. Data collection included surgery type, sex, age, body mass index (BMI), and comorbidities (hypertension, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea (OSA)). Patients aged 65 years old or older were matched with controls younger than 65 years by body mass index (BMI). We assessed length of stay (LOS), perioperative and early postoperative outcomes, short-term weight loss, and complications. RESULTS We included 150 bariatric patients, with a case-to-control ratio of 1:2. After laparoscopic sleeve gastrectomy, no significant difference was found in LOS between groups (2.4 vs 2.6 days; P = 0.52), 1-month BMI difference (3.35 vs 3.88; P = 0.17), mean nadir excess BMI loss (%EBL) (22.14 vs 23.2; P = 0.75), or complication rate (0% vs 3.3%; P > 0.99). Similarly, the laparoscopic or robotic-assisted Roux-en-Y gastric bypass (RYGB) cohort showed no difference in LOS (2.65 vs 2.54 days; P = 0.68), 1-month BMI difference (4.72 vs 4.53; P = 0.68), %EBL (31.7 vs 26.6; P = 0.13), or complication rate (11.7% vs 5.71%; P = 0.43). CONCLUSION Although the sample size is small to draw definitive conclusions, bariatric surgery in patients 65 years or older seems to be safe, with similar outcomes and complication rates as in younger patients, regardless of procedure performed.
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Affiliation(s)
| | | | - Enrique F Elli
- General Surgery, Mayo Clinic, Jacksonville, FL, USA. .,Department of Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Froylich D, Sadeh O, Mizrahi H, Kafri N, Pascal G, Daigle CR, Geron N, Hazzan D. Midterm outcomes of sleeve gastrectomy in the elderly. Surg Obes Relat Dis 2018; 14:1495-1500. [PMID: 30177427 DOI: 10.1016/j.soard.2018.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/24/2018] [Accepted: 07/22/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The increase in life expectancy presents health systems with a growing challenge in the form of elderly obesity. Bariatric surgery has been shown to be a safe and effective treatment for obesity with reduction of excess weight and improvement in obesity-related co-morbidities. However, only recently have surgeons begun performing these operations on elderly patients on a larger scale, making data regarding mid- and long-term outcomes scarce. The objective of this study was to evaluate the safety and midterm efficacy of laparoscopic sleeve gastrectomy (LSG) in patients aged ≥60 years. METHODS All patients aged ≥60 years who underwent LSG between 2008 and 2014 and achieved ≥24-month follow-up were retrospectively reviewed. Demographic characteristics and perioperative data were analyzed. Weight loss parameters and co-morbidity resolution rates were compared with preoperative data. RESULTS In total 55 patients aged ≥60 years underwent LSG. Mean patient age was 63.9 ± 3.2 years (range, 60-75.2), and mean preoperative body mass index was 43 ± 6.0 kg/m2. Perioperative morbidity included 5 cases of hemorrhage necessitating operative exploration, 2 cases of reduced hemoglobin levels treated with blood transfusion, and 1 case of portal vein thrombosis managed with anticoagulation. There were no mortalities. Mean follow-up time was 48.6 (range, 25.6-94.5) months. Mean percentage of excess weight loss was 66.4 ± 19.7, 67.5 ±1 6.4, 61.4 ± 18.3, 66.7 ± 25.6, 50.7 ± 21.4 at 12, 24, 36, 37 to 60, and 61 to 96 months, respectively. Statistically significant improvement of type 2 diabetes, hypertension, and dyslipidemia were observed at the latest follow-up (P < .01). CONCLUSION LSG offers an effective treatment of obesity and its co-morbidities in patients aged ≥60 years, albeit with a high perioperative bleeding rate at our center; efficacy is maintained for at least 4.5 years.
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Affiliation(s)
- Dvir Froylich
- Surgery B Department, Carmel Medical Center, Haifa, Israel.
| | - Omer Sadeh
- Surgery B Department, Carmel Medical Center, Haifa, Israel
| | - Hagar Mizrahi
- General Surgery Department, The Baruch Padeh Medical Center, Poriya, Israel
| | - Naama Kafri
- Surgery B Department, Carmel Medical Center, Haifa, Israel
| | - Guy Pascal
- Surgery B Department, Carmel Medical Center, Haifa, Israel
| | | | - Nisim Geron
- General Surgery Department, The Baruch Padeh Medical Center, Poriya, Israel
| | - David Hazzan
- Surgery B Department, Carmel Medical Center, Haifa, Israel
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19
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Susmallian S, Barnea R, Weiss Y, Raziel A. Outcome of bariatric surgery in older patients. Surg Obes Relat Dis 2018; 14:1705-1713. [PMID: 30241999 DOI: 10.1016/j.soard.2018.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND People are living longer than they were expected to 2 decades ago. Increased life expectancy and reduced mortality encompasses a simultaneous increase in the number of older adults with obesity that entails an increase of co-morbidities, such as diabetes, hypertension, cancer, and many other diseases. The aim of our study was to compare the outcomes of bariatric surgery in patients age ≥65 in comparison with younger patients. METHODS This retrospective study compares bariatric surgeries performed in a private institution between the years 2013 and 2015. The study included 9044 patients divided into an older group (451 patients) and the younger group (8593 patients). RESULTS In the younger group, bariatric surgery is distributed as follows: 77.68% sleeve gastrectomy, 12.72% gastric banding, 9.27% gastric bypass, and .33% duodenal switch or biliopancreatic diversion; in the older group: 70.51% sleeve gastrectomy, 15.08% gastric bypass, 13.97% gastric band, and .44% biliopancreatic diversion. In the control group 550 cases (6.4%) underwent revisional surgery; 64 cases (14.10%) underwent revision in the older group. Older patients lost less excess weight than younger patients (72.44% versus 86.11%, respectively). Older patients presented higher rates of complications (8.42% versus 5.59%), co-morbidities (77.60% versus 55.45%), and revisions (1.33% versus .77%). There was no statistical difference in hospital stay between older group and control group (2.27 versus 2.23, respectively). When performing a Clavien-Dindo classification, we demonstrated significant differences in class 3B and 4A and no differences in other classes. Two deaths occurred in the control group. Diabetes, fatty liver, and sleep apnea have been improved or remitted in >90% of patients in both groups, hypertension and hyperlipidemia by >80%, and hyperuricemia and ischemic heart disease were improved or resolved in >70% of the patients CONCLUSIONS: Bariatric surgery in the elderly has more complications, but it can still be considered safe.
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Affiliation(s)
| | - Royi Barnea
- Assuta Health Services Research Institute, Assuta Medical Center, Tel-Aviv, Israel
| | - Yossi Weiss
- Assuta Health Services Research Institute, Assuta Medical Center, Tel-Aviv, Israel; Ariel University, Israel
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
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20
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Bergeat D, Lacaze L, Sulpice L, Boudjema K, Thibault R. In Response to: "The Outcome of Bariatric Surgery in Patients Aged 75 Years and Older". Obes Surg 2018; 28:3308-3309. [PMID: 30094575 DOI: 10.1007/s11695-018-3456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Damien Bergeat
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Rennes, France. .,Université de Rennes 1, Rennes, France. .,Univ Rennes, INSERM, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000, Rennes, France.
| | - Laurence Lacaze
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Rennes, France.,Université de Rennes 1, Rennes, France.,Univ Rennes, INSERM, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000, Rennes, France
| | - Laurent Sulpice
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Rennes, France.,Université de Rennes 1, Rennes, France
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Rennes, France.,Université de Rennes 1, Rennes, France
| | - Ronan Thibault
- Université de Rennes 1, Rennes, France.,Univ Rennes, INSERM, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000, Rennes, France.,Unité de Nutrition, CHU Rennes, F-35000, Rennes, France
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Billeter AT, Müller-Stich BP. Comment on: impact of age on risk of complications after gastric bypass: a cohort study from the Scandinavian Obesity Surgery Registry (SOReg). Surg Obes Relat Dis 2018; 14:443-444. [PMID: 29478816 DOI: 10.1016/j.soard.2018.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Adrian T Billeter
- Department of General, Visceral, and Transplantation Surgery University of Heidelberg Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery University of Heidelberg Heidelberg, Germany
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