Laparoscopic Sleeve Gastrectomy in Patients Over 60 Years Old: A Long-Term Follow-Up

Purpose: This study analyzed the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in patients over 60 years old, in a long-term follow-up, in a high-volume bariatric center. Methods: We retrospectively analyzed all patients older than 60 years who underwent LSG in our center from January 2009 to December 2018. A prospectively collected database of 4991 consecutive LSG cases was reviewed. Results: One hundred seventy-nine sleeve gastrectomy procedures were performed in patients older than 60 years, 135 were aged 60-65 years (group A) and 44 were older than 65 years (group B). We reported five cases (2.7%) of early complications: three postoperative hemorrhages, one cardial leakage, and one perigastric abscess. No thromboembolic events or mortality rates were reported. The mean follow-up period was 5.5 years (66 months). The follow-up loss rate was about 29%. At last follow-up, the mean body-mass index/body mass/percentage of excess weight loss values were, respectively, 33.7 ± 7/86.1 ± 21/60.4 ± 28.6 in group A and 32.4 ± 6.4/82.6 ± 18/61.8 ± 33 in group B. We reported 5 (4.0%) trocar site hernias, 1 (0.8%) cardial junction stenosis, and 22 (18%) new outbreaks of gastroesophageal reflux (GERD). There were 7 reinterventions (5.7%): 5 for weight regain and 2 for GERD not responding to medical therapy. There were no statistically significant differences between the two age groups. Conclusions: LSG is a safe and effective treatment for severe obesity in people over 60 years old. There are no differences in results of patients over 65 years and between 60 and 65 years old. Scales that include associated medical problems and the patient's general condition must be considered.

Bariatric and Metabolic Surgery in Patients Older than 65 Years - a Multicenter Study

INTRODUCTION

With the increase in life expectancy and a growing number of people suffering from obesity, bariatric and metabolic surgery is becoming a major concern in the elderly population. The study aimed to collect, systematize and present the available data on the surgical treatment of obesity among Polish patients over 65 years of age.

MATERIAL AND METHODS

A retrospective study analysed patients over 65 years who underwent laparoscopic bariatric procedures in Poland from 2008 to 2022. The efficacy endpoints were percentage of excess weight loss (EWL%), percentage of total weight loss (%TWL), improvement in obesity-related diseases.

RESULTS

The group consisted of 284 patients (173 women, 60.9%). The mean follow-up was 47.5 months. The mean BMI before surgery was 43.1 kg/m2. 146 (51.4%) patients had T2D, and 244 (85.9%) had HT. The most common procedure was sleeve gastrectomy (82.0%). The mean EWL% after surgery was 50.9%, and the mean TWL% after surgery was 20.6%. There was the statistically significant difference between AGB vs OAGB, SG vs OAGB in %EWL (p = 0.0116, p = 0.009, respectively) and RYGB vs OAGB in %TWL (p = 0.0291). After surgery, 93 patients (63.7%) had complete or partial remission of T2D, and 112 patients (45.9%) had complete or partial remission of HT.

CONCLUSION

Bariatric surgery appears to be a safe and effective method of treatment of obesity in patients over 65 years of age. OAGB seems to have better results in weight loss than SG, RYGB, and AGB in older patients.

A 5-year characterization of trends and outcomes in elderly patients undergoing elective bariatric surgery

BACKGROUND

The North American population with severe obesity is aging and with that so will the number of elderly patients (≥ 65 years) meeting indications for metabolic surgery. Trends in bariatric delivery in this population are poorly characterized and outcomes remain conflicting, limiting potential uptake and delivery.

METHODS

The MBSAQIP database was used to identify elderly patients (≥ 65 years) undergoing elective bariatric surgery from 2015 to 2019. Our objectives were to analyze their unique characteristics, surgical operative trends, and outcomes by comparing to a non-elderly cohort. Multivariable logistic regression identified independent predictors of serious complications and 30-day mortality.

RESULTS

There was a total of 751,607 patients, 5.3% (n = 39,854) were elderly. Mean ages were 43 ± 11 years (non-elderly) versus 68 ± 3 years (elderly). Elderly patients were less likely to be female (70.7% elderly; 80.1% non-elderly) and had lower BMI (43.17 ± 6.64 kg/m² elderly; 45.42 ± 7.87 kg/m² non-elderly). They had higher American Society of Anesthesiologists classification, lower functional status, more insulin dependent diabetes, and hypertension, among other comorbidities. There were no clinically significant differences between the most frequently performed bariatric surgery. Sleeve gastrectomy remained the most common (73.7% non-elderly; 72.3% elderly); however, operative time was longer among the elderly. Functional status was most predictive for both serious complications (OR 1.72; CI 1.53-1.94) and mortality (OR 2.92; CI 1.98-4.31). Surgery among elderly patients was associated with poorer 30-day postoperative outcomes across all categories and was independently associated with serious complications (OR 1.23; CI 1.17-1.30, p < 0.001; AR 4.64%) and 30-day mortality (OR 2.49; CI 2.00-3.11, p < 0.001; AR 0.27%), after adjusting for comorbidities.

CONCLUSIONS

After adjusting for comorbidities, functional status remains the most predictive factor for poor outcomes; however, elderly patients have increased 30-day odds of serious complications and 30-day mortality, suggesting a need to tailor our approach to these individuals that carry a unique operative risk.

Application and progress of palliative therapy in advanced gastric carcinomas

Gastric carcinomas have high morbidity and mortality. It produces no noticeable symptoms in the early stage while causing complex complications in its advanced stage, making treatment difficult. Palliative therapy aims to relieve the symptoms of cancer patients and focuses on improving their quality of life. At present, five palliative therapies for advanced gastric carcinomas are offered: resection, gastrojejunostomy, stenting, chemotherapy, and radiotherapy. In recent years, palliative therapy has been used in the clinical treatment of advanced gastric carcinomas and related complications because of its efficacy in gastric outlet obstruction and gastric bleeding. In the future, multimodal and interdisciplinary palliative therapies can be applied to control general symptoms to improve patients’ condition, prolong their lifespan and improve their quality of life.

Weight Loss After Bariatric Surgery in Different Age Groups

PURPOSE

Weight loss after bariatric operations may be reduced in older patients due to changes in metabolism. Some studies showed inferior weight loss in older patients compared to younger ones while others showed no such difference. In order to counsel patients about the expected weight loss after bariatric surgery, recommendations stratified by age are important.

METHODS

This study encompasses a retrospective analysis of 500 consecutive patients with RYGB or sleeve gastrectomies from a single institution with a mean follow-up time of 3.6 years. Patients were stratified into five groups according to age at the time point of the operation: < 30 years, 30-39 years, 40-49 years, 50-59 years, and ≥ 60 years.

RESULTS

Weight loss expressed in percent excessive body mass index loss (%EBMIL) at nadir were 86.6, 89.5, 84.0, 77.9, and 76.4% and 75.6, 78.4, 73.3, 68.0, and 69.0% at the time of last follow-up for the five groups, respectively. Weight loss was significantly higher in younger patients than in older patients for both time points. The total number of comorbidities that showed complete remission (normal values without treatment), was also significantly higher in the younger age groups.

CONCLUSIONS

Primary bariatric operations yield better weight loss results and remission rates of obesity related comorbidities in younger patients, but are still effective in older individuals.

Impact of bariatric surgery in elderly patients with obesity

INTRODUCTION

to evaluate the long-term impact of bariatric surgery in the elderly population.

METHODS

a retrospective study including all patients older than 60 years who underwent Roux-en-Y gastric bypass (RYGB) at our center and maintained a follow-up longer than 1 year. Clinical and laboratory variables were studied to assess remission of obesity and its comorbidities, as well as variables directly related to the surgical procedure itself, including early and late complications.

RESULTS

fifty-six patients were studied, mostly female (76,8%), with a mean age of 64.02 ± 3.34. A rate of complications of 37,5% was observed, with 10,7% requiring hospital admission and emergency surgery. The mean excess weight loss (%EWL) was 74.22% ± 26.76. The remission rates of hypertension and diabetes mellitus were 26.08% and 54.54%, respectively. There was significant difference in BMI reduction (12.25 ± 5.42, p<0.001), total cholesterol (31.37 ± 38.89 p<0,001), LDL cholesterol (23.45 ± 34.9, p=0.002), HDL cholesterol (5.14 ± 11.13, p=0,024), triglycerides (48.85 ± 56.15 p<0.001), HbA1C (1,81 ± 1,97, p<0,001) e PCR (1.43 ± 1.96, p<0.001).

CONCLUSION

bariatric surgery was effective in weight loss and remission of comorbidities in the elderly obese population within the long term.

Impacto da cirurgia bariátrica em pacientes idosos portadores de obesidade

RESUMO Introdução: avaliar o impacto da cirurgia bariátrica na população idosa no longo prazo. Métodos: estudo retrospectivo que incluiu todos os pacientes com mais de 60 anos submetidos ao Bypass gástrico em Y de Roux (BGYR) em nosso centro e que mantiveram seguimento superior a 1 ano. Foram estudadas variáveis clínicas e laboratoriais para avaliação da remissão da obesidade e suas comorbidades, além de variáveis diretamente relacionados ao procedimento cirúrgico em si, incluindo complicações precoces e tardias. Resultados: foram estudados 56 pacientes, a maioria do sexo feminino (76,8%), com idade média de 64,02 ± 3,34. Foi observada uma taxa de complicações de 37,5%, com 10,7% requerendo internamento hospitalar e cirurgia de urgência. A média geral da perda do excesso de peso (%PEP) foi de 74,22% ± 26,76. As taxas de remissão de hipertensão e diabetes mellitus foram de 26,08% e 54,54%, respectivamente. Houve variação significativa no IMC (12,25 ± 5,42, p<0,001), colesterol total (31,37 ± 38,89 p<0,001), colesterol LDL (23,45 ± 34,9, p=0,002), colesterol HDL (5,14 ± 11,13, p=0,024), triglicerídeos (48,85 ± 56,15 p<0,001), HbA1C (1,81 ± 1,97, p<0,001) e PCR (1,43 ± 1,96, p<0,001). Conclusão: a cirurgia bariátrica se mostrou eficaz na perda de peso e na remissão de comorbidades na população de idosos com obesidade no longo prazo..

Postoperative 4-Year Outcomes in Septuagenarians Following Bariatric Surgery

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.

Obesity and perioperative outcomes in older surgical patients undergoing elective spine and major arthroplasty surgery

STUDY OBJECTIVE

To determine whether obesity status is associated with perioperative complications, discharge outcomes and hospital length of stay in older surgical patients.

DESIGN

Secondary analysis of five independent study cohorts (N = 1262).

SETTING

An academic medical center between 2001 and 2017 in the United States.

PATIENTS

Patients aged 65 years or older who were scheduled to undergo elective spine, knee, or hip surgery with an expected hospital stay of at least 2 days.

MEASUREMENTS

Body mass index (BMI) was stratified as nonobese (BMI ≤ 30 kg/m2), obesity class 1 (30 kg/m2 ≤ BMI < 35 kg/m2) or obesity class 2-3 (BMI ≥ 35 kg/m2). Primary outcomes included predefined intraoperative and postoperative complications, hospital length of stay (LOS), and discharge location. Univariate and multivariate logistic regression was performed.

MAIN RESULTS

Obesity status was not associated with intraoperative adverse events. However, obesity class 2-3 significantly increased the risk for postoperative complications (IRR 1.43, 95% CI 1.03-1.95, P = 0.03), hospital LOS (IRR 1.13, 95% CI 1.02-1.25, P = 0.02) and non-home discharge destination (OR 1.95, 95% CI 1.35-2.81, P < 0.001) after accounting for patient related factors and surgery type.

CONCLUSIONS

Obesity class 2-3 status has prognostic value in predicting an increased incidence of postoperative complications, increased hospital LOS, and non-home discharge location. These results have important clinical implications for preoperative informed consent and provide areas to target for care improvement for the older obese individual.

Racial disparities in bariatric perioperative outcomes among the elderly

BACKGROUND

Bariatric surgery outcomes in elderly patients have been shown to be safe, but with a higher rate of adverse outcomes compared with nonelderly patients. The impact of race on bariatric surgery outcomes continues to be explored, with recent studies showing higher rates of adverse outcomes in black patients. Perioperative outcomes in racial cohorts of elderly bariatric patients are largely unexplored.

OBJECTIVE

The goal of this study was to compare outcomes between elderly non-Hispanic black (NHB) and non-Hispanic white (NHW) bariatric surgery patients to determine whether outcomes are mediated by race.

SETTING

Academic hospital.

METHODS

Patients who had a primary Roux-en-Y (RYGB) and sleeve gastrectomy (SG) in the period 2015-2018 and were at least 65 years of age were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Data File (MBSAQIP PUF). Selected cases were stratified by race. Outcomes were compared between matched racial cohorts. Multivariate regression analyses were performed to determine whether race independently predicted morbidity.

RESULTS

From 2015 to 2018, 29,394 elderly NHW (90.8%) and NHB (9.2%) patients underwent an RYGB or SG. At baseline, NHB elderly patients had a higher burden of co-morbid conditions, resulting in higher rates of overall (7.7% versus 6.4%, P = .009) and bariatric-related (5.4% versus 4.1%, P = .001) morbidity. All outcome measures were similar between propensity-score-matched racial elderly bariatric patient cohorts. On regression analysis, NHB race remained independently correlated with morbidity (odds ratio [OR] 1.3, 95% CI 1.08-1.47, P = .003).

CONCLUSION

RYGB and SG are safe in elderly patient cohorts, with no differences in adverse outcomes between NHB and NHW patients, accounting for confounding factors. While race does not appear to impact outcomes in the elderly cohorts, NHB race may play a role in access.

Gastrojejunocolic fistula: case report of a rare late complication of laparoscopic Roux-en-Y gastric bypass and review of the literature

INTRODUCTION

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is known as the weight loss surgery to which other bariatric procedures are compared. While morbidity and mortality of this procedure are low, serious complications do exist which can be life-threatening and sometimes require surgical correction.

CASE PRESENTATION

A 63-year-old woman underwent LRYGB outside of the United States, later complicated by biliary colic treated with cholecystectomy and upper gastrointestinal bleeding secondary to H. pylori-related ulcer at her gastrojejunostomy. Following adequate treatment of the patients marginal ulcer, the patient experienced several months of progressive severe abdominal pain, frequent vomiting and diarrhea, and unintentional weight loss refractory to pharmacologic therapy. The patient underwent multiple medical and endoscopic evaluations unrevealing of an organic cause of her symptoms. At presentation, the patient was found to be profoundly weak, dehydrated and malnourished with metabolic derangements and was subsequently diagnosed with a gastrojejunocolic fistula via upper endoscopy and radiography. We provided excluded stomach gastrostomy tube feeding to the patient for three months to improve the patients nutritional status before definitive surgical correction was successfully performed.

DISCUSSION

Large bowel fistulas are a rare and highly morbid late complication following LRYGB and are likely secondary to marginal ulcers and/or instrumentation such as endoscopy. Surgery represents the definitive treatment.

CONCLUSION

LRYGB is typically a safe and effective intervention for obesity. Large bowel fistulas are rare complications following this surgery. We highlight difficulties in diagnosing and treating this condition.

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

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.

Bariatric surgery in over 60 years old patients: is it worth it?

The high prevalence of obesity in the elderly and the increase in life expectancy pushed up the age limit as an indication to bariatric surgery. Nevertheless, results on safety and effectiveness of these procedures in over 60 years old population are still controversial. Objectives of the study were to evaluate the safety and effectiveness of bariatric surgery in the elderly. A prospectively collected database was queried for patients older than 60 years who underwent laparoscopic bariatric procedures between 2010 and 2017 at a single institution. These patients were matched with a group of younger patients who had the same procedure in the same period of time. Basal characteristic, intra- and post-operative data were compared. Patients were followed up at 36 months reporting the percentage of excess weight loss (%EWL) and comorbidities remission rate. A total of 100 patients ≥ 60 years old were included (Group 1) and matched with a control group of 96 patients < 60 years (Group 2). Post-operative complications rate was similar (15.0% versus 10.4% p = 0.395). %EWL at 36 months was significantly higher in Group 2 (44.6% versus 68.2% p < 0.001), while remission of medical morbidities was similar in both groups, with a higher rate for type 2 diabetes (T2D) remission among older people (p = 0.017). Patients older than 60 years have post-operative outcomes comparable to younger population. Long-term results are inferior in terms of %EWL, but similar regarding morbidities remission rates, with particular benefits on T2D.

Propensity Score-Matching Sleeve Gastrectomy (SG) vs. Gastric Bypass (RYGB) in Patients ≥ 60 Years

BACKGROUND

Since 1 January 2005, the practice of bariatric surgery has been examined with the help of the German Bariatric Surgery Registry (GBSR) in Germany. The focus of the study was to evaluate if sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) has the best benefit in terms of perioperative risk in patients over 60 years of age.

METHODS

Data collection includes patients over the age of 60 years who underwent SG or RYGB between 2005 and 2017. The bougie is limited to 33-40 French for SG. Furthermore, the RYGB is determined to be 120-180 cm alimentary and 40-60 cm biliopancreatic length. Outcome criteria are perioperative morbidity, postoperative complications, 30-day mortality, and postoperative length of stay.

RESULTS

The study analyzes data from 3561 patients beyond the age of 60 years who underwent SG (1970 patients) and RYGB (1591 patients). Mean age of the patients was 63.4 ± 3.2 in the RYGB group and 63.8 ± 3.5 in the SG group. Mean BMI was 46.4 ± 6.8 in the RYGB group and 49.1 ± 8.0 in the SG group. The average number of comorbidities was 4.5 ± 2.4 for RYGB and 4.5 ± 2.3 for SG. For the 30-day mortality, identical results were found SG vs. RYGB (0.31 vs. 0.38, p = 1.000).

CONCLUSION

Based on the results of this study, it can be concluded that both SG and RYGB in patients ≥ 60 years can be considered safe surgical procedures.

Factors affecting weight loss variability in obesity

Current obesity treatment strategies include diet, exercise, bariatric surgery, and a limited but growing repertoire of medications. Individual weight loss in response to each of these strategies is highly variable. Here we review research into factors potentially contributing to inter-individual variability in response to treatments for obesity, with a focus on studies in humans. Well-recognized factors associated with weight loss capacity include diet adherence, physical activity, sex, age, and specific medications. However, following control for each of these, differences in weight loss appear to persist in response to behavioral, pharmacological and surgical interventions. Adaptation to energy deficit involves complex feedback mechanisms, and inter-individual differences likely to arise from a host of poorly defined genetic factors, as well as differential responses in neurohormonal mechanisms (including gastrointestinal peptides), metabolic efficiency and capacity of tissues, non-exercise activity thermogenesis, thermogenic response to food, and in gut microbiome. A better understanding of the factors involved in inter-individual variability in response to therapies will guide more personalized approaches to the treatment of obesity.

Nutrition and Weight Management in the Elderly

"Aging alters the way the body digests food, absorbs nutrients, and metabolizes energy. Changes in deglutition, digestion, and metabolism in this population are well described and may lead to alterations in oral intake, body composition, and overall health status. Elderly persons are at high risk for developing sarcopenia as well as sarcopenic obesity characterized by accelerated reduction in lean muscle mass and enhancement of body fat. Nutritional screening is important to identify high-risk individuals and facilitate care management planning. The most common assessment tool in elderly patients is the Mini Nutritional Assessment, which analyzes oral intake, health status, and anthropometrics."

One-year outcomes of bariatric surgery in older adults: a case-matched analysis based on the Tehran Obesity Treatment Study

PURPOSE

Knowledge is limited about the efficacy, safety, and long-term outcomes of bariatric surgery in older adult patients with obesity.

METHODS

Fifty-six patients aged ≥ 60 years who underwent bariatric surgery, as either sleeve gastrectomy or gastric bypass, were matched for sex, baseline body mass index (BMI) and surgery type, with 112 younger controls, aged 18-60 years. We compared complications, weight loss, resolution of co-morbidities, and changes in body composition status (fat mass [FM], fat-free mass [FFM], lean mass [LM] and percentage of fat mass [FM%]) 12 months postoperatively between the groups.

RESULTS

Complications were similar in the two groups. Diabetes mellitus (DM) and dyslipidemia showed similar remission and improvement rates postoperatively in the two groups. Remission from hypertension (HTN) was higher in the control group, but improvement rates were similar. Changes from baseline to 12 months postoperatively in weight, BMI, excess weight loss (EWL%), total weight loss (TWL%), FFM, and LM were greater in the control group than in the older-age group. Changes in FM and FM% were similar in the two groups.

CONCLUSION

Bariatric surgery is a safe intervention for the management of obesity and obesity-related co-morbidities in older adults, with similar surgery-risk and complication rates to those of younger adults. Reduction in FM and FM% was equal in two groups and the concern about greater LM loss in older adults seems unfounded.

Recommendations Based on Evidence by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the Pre- and Postoperative Management of Patients Undergoing Obesity Surgery

In order to develop evidence-based recommendations and expert consensus for nutrition management of patients undergoing bariatric surgery and postoperative follow-up, we conducted a systematic literature search using PRISMA methodology plus critical appraisal following the SIGN and AGREE-II procedures. The results were discussed among all members of the GARIN group, and all members answered a Likert scale questionnaire to assess the degree of support for every recommendation. Patients undergoing bariatric surgery should be screened preoperatively for some micronutrient deficiencies and treated accordingly. A VLCD (Very Low-Calorie Diet) should be used for 4-8 weeks prior to surgery. Postoperatively, a liquid diet should be maintained for a month, followed by a semi-solid diet also for one month. Protein requirements (1-1.5 g/kg) should be estimated using adjusted weight. Systematic use of specific multivitamin supplements is encouraged. Calcium citrate and vitamin D supplements should be used at higher doses than are currently recommended. The use of proton-pump inhibitors should be individualised, and vitamin B12 and iron should be supplemented in case of deficit. All patients, especially pregnant women, teenagers, and elderly patients require a multidisciplinary approach and specialised follow-up. These recommendations and suggestions regarding nutrition management when undergoing bariatric surgery and postoperative follow-up have direct clinical applicability.

A Propensity Score Cohort Study on the Long-Term Safety and Efficacy of Sleeve Gastrectomy in Patients Older Than Age 60

BACKGROUND

Bariatric surgery (BS) in older obese subjects (>60 years of age) has risen in the past decade and will continue to rise in the coming years due to ageing of the population.

AIM

To evaluate the short- (12 months) and long-term (60 months) results of laparoscopic sleeve gastroscopy (LSG) in patients older than age 60.

METHODS

We performed a retrospective review of patients prospectively included in a database from January 2007 to December 2013. All patients >60 [older group (OG)] who had undergone LSG were included. The control group (CG) included patients aged 50 to 59 years who had undergone LSG during the same period.

RESULTS

116 (8.4 % of total surgery) and 145 patients were included in the OG and CG, respectively. BS in patients >60 years increased from 2.4% in 2003 to 14% in the last 2 years of the study. After inverse probability of treatment weighting (IPTW) analysis, all absolute standardized differences were <0.15. A 60-month follow-up was attained in 90% of patients in the OG and 74% in the CG. There were no significant differences in postoperative complications between the two groups. At 12 and 60 months after LSG, both groups achieved a similar body mass index. There was no statistical difference in the percentage of resolution of type 2 diabetes, hypertension, dyslipidemia, and SAHS between the two groups. In both groups, all the nutritional parameters evaluated remained within the normal range throughout the study.

CONCLUSIONS

LSG provides acceptable outcomes and is safe in older adults indicating that age should not be a limitation to perform BS in this population.

Older Age Confers a Higher Risk of 30-Day Morbidity and Mortality Following Laparoscopic Bariatric Surgery: an Analysis of the Metabolic and Bariatric Surgery Quality Improvement Program

INTRODUCTION

There is a paucity of literature describing the association of age with the risk of adverse events following bariatric surgery. The purpose of this study is to investigate the association of age with 30-day morbidity and mortality following laparoscopic bariatric surgery using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

METHODS

All adult patients undergoing laparoscopic Roux-en-Y gastric bypass (RNGYB) or sleeve gastrectomy (SG) were identified within the MBSAQIP database. Patients were divided into five equal age quintiles. Binary outcomes of interest, including cardiac, pulmonary, wound, septic, clotting, and renal events, in addition to the incidence of related 30-day unplanned reintervention, related 30-day mortality, and a composite morbidity and mortality outcome were compared across the age quintiles and procedures.

RESULTS

A total of 266,544 patients met inclusion criteria. Older age was associated with an increased risk of all morbidity outcomes except venous thromboembolism events, 30-day mortality, and the composite morbidity and mortality outcome. Patients who underwent Roux-en-Y gastric bypass had worse outcomes per quintile for almost every outcome of interest when compared to patients who underwent sleeve gastrectomy.

CONCLUSION

Older patients and patients who undergo Roux-en-Y gastric bypass are at an increased risk of perioperative morbidity and mortality following laparoscopic bariatric surgery. Additional studies are needed to determine the association of age with long-term weight loss and cardiometabolic comorbidity resolution following bariatric surgery in order to determine if the increased perioperative risk is offset by improved long-term outcomes in older patients undergoing bariatric surgery.

Surgical Morbidity in the Elderly Bariatric Patient: Does Age Matter?

BACKGROUND

Obesity is a global health problem that also affects older adults. In Chile, as in most of the developing countries, more than half of older adults are overweight or obese, and bariatric surgery may be riskier for this group. The aim of this study is to compare our experience in patients over 60 years of age with a control group to determine associated surgical morbidity and mortality.

METHODS

Case-control study of bariatric surgeries performed between 2006 and 2017 in our institution. Patients aged ≥ 60 years for the case group versus control group for patients ≤ 50 years selected randomly, matched by body mass index, type 2 diabetes, hypertension, dyslipidemia, surgical technique, and gender (ratio 1:2). Primary endpoint was surgical morbidity, 30-day readmission, and mortality.

RESULTS

Seventy-two patients in case group were matched with 144 patients in control group. Surgical complications rate was the same for both groups. No differences were observed in the conversion to open surgery rate or 30-day readmission rate. There was no mortality in this series.

CONCLUSION

In this case-control study, being elderly does not increase the risk of morbidity and mortality associated with bariatric surgery.

A Retrospective Study of 6-Month Reduction in Risk of Developing Cardiovascular Diseases and Type 2 Diabetes Mellitus in Severely Obese Patients Over 60 Years of Age Following Bariatric Surgery

BACKGROUND Controversy exists with regard to the effectiveness and reasons for bariatric procedures in patients older than 60 years. The goal of our study was to determine the reduction in risk of developing cardiovascular disease and type 2 diabetes mellitus after undergoing bariatric surgery in obese patients over age 60 at our institution. MATERIAL AND METHODS Patients with severe obesity (BMI >40 kg/m²) were retrospectively included in the study. Risk of cardiovascular disease and type 2 diabetes at baseline and their reduction during the follow-up period were evaluated with the following selected, currently preferred risk algorithms: (1) the Systemic Coronary Risk Evaluation (SCORE) scale; (2) the Framingham Risk Score (of myocardial infarction or coronary death) for patients with no prior history of diabetes, coronary heart disease, or intermittent claudication; and (3) the Framingham Offspring Diabetes Risk Score, which estimates the 8-year risk of developing type 2 diabetes. RESULTS All 33 elderly patients (32 women and 1 man, mean age 62.3±2.7 (BMI 44.3±6.2 kg/m²) significantly reduced their risk levels. We observed a decrease in the 10-year risk of a first fatal cardiovascular event (3.5±0.5 vs. 2.4±0.5, absolute risk reduction [ARR] 1.0); reduced 10-year risk of myocardial infarction or death (5.0±1.6 vs. 3.25±1.6, ARR 1.7); and reduced predicted 8-year risk of developing type 2 diabetes (7.4±7.2 vs. 3.1±0.3, ARR 4.3). No intra- or postoperative complications were observed. CONCLUSIONS Our study showed a significant reduction in risk of developing cardiovascular diseases and type 2 diabetes, as measured by available risk scores, in elderly patients undergoing bariatric procedures.

Analysis of the Association between Eating Behaviors and Weight Loss after Laparoscopic Sleeve Gastrectomy

SETTING

In a private medical center, 300 patients who underwent a laparoscopic sleeve gastrectomy (LSG) were classified into 4 groups according to their eating behaviors (EB) preoperatively. During a 3-year postoperative follow-up, dietary changes in relation to weight loss were studied.

OBJECTIVES

To explore the influence of abnormal EB on the outcome of sleeve gastrectomy.

BACKGROUND

Patients with morbid obesity often suffer from abnormal EB. After LSG, the outcome depends largely on improvement of the feeding behaviors acquired.

METHODS

This prospective study includes 300 patients who underwent LSG from 2013 to 2014, divided into the following 4 groups: binge eaters, snack eaters, sweet eaters, and volume eaters.

RESULTS

The average age was 41.65 years, the ratio of male to females was 1 to 2. The average baseline body mass index (BMI) was 42.02. After 3 years, no significant change was found in the number of binge eaters (p = 0.396), but there was an 8.9% increase in snack eaters (p < 0.001), a 12.9% increase in sweet eaters (p < 0.001), and 17.2% increase in healthy eating habits (p < 0.001). Sixty-five (24.8%) patients did not experience changes in their eating patterns. However, after surgery, 24.6% of the patients continued with the same EB and 125 (49.5%) patients changed from one EB to another unhealthy EB. Weight loss, measure as ΔBMI, was similar in each group after 3 years, with a mean BMI of 29.8. When eating habits were related to different features such as gender, sports practice, type of work, smoking, marital status, comorbidities, no influence on the operative results were found.

CONCLUSION

LSG promotes the reduction of overeaters; however, it promotes a switch between other unhealthy EB. The significant increase in snack eaters and sweet eaters is outstanding, although it did not affect weight loss in the midterm follow-up. Worsening of eating habits after LSG is a common fact.

Impact of age on postoperative outcomes in bariatric surgery

BACKGROUND

Age is often related to the increase of perioperative complications and reoperation rates. The authors aimed to determine the influence of age on outcomes of most commonly performed bariatric procedures.

METHODS

The retrospective study included patients qualified for primary Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) in two academic hospitals. Patients were divided into two groups: ≥50 (21.2-26.9%) and <50 (57.6-73.1%) years old. Endpoints assessed the influence of patients' age on the perioperative and the one-year postoperative period.

RESULTS

Operative time was longer in the ≥50-year-old group, but only for LRYGB. There were no differences in the intraoperative adverse events, postoperative morbidity, reoperation and readmission rates between the groups. The risk of port site hernia was increased (OR: 4.23, CI: 1.49-12.06) in the ≥50-year-old group. The mean % of total weight loss 12 months after the bariatric procedure was comparable, but % of excess weight loss and % of excess body mass index loss were lower in the ≥50-year-old group (p = .033 and .032).

CONCLUSIONS

Bariatric surgery is safe and feasible in patients over 50 years old. The weight loss effect can be worse among patients over 50 years old; nevertheless, the treatment should be considered as effective.

Bariatric patients' nutritional status as a risk factor for postoperative complications, prolonged length of hospital stay and hospital readmission: A retrospective cohort study

BACKGROUND

The prevalence of obesity is growing worldwide. Malnutrition has been identified as a risk factor, leading to higher morbidity rate and prolonged length of hospital. So far there are no high quality data on the impact of malnutrition on length of hospital stay and morbidity regarding bariatric surgery. The aim of the study was to assess association between nutritional status and outcomes bariatric surgeries.

MATERIAL AND METHODS

The study was a prospective observational study.

INCLUSION CRITERIA

informed consent to participate in the study, age 18-65 years, meeting the eligibility criteria for bariatric treatment, qualification for laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y Gastric By-pass (LRYGB).

EXCLUSION CRITERIA

revision surgery, lack of necessary data. The primary endpoint was the evaluation of protein malnutrition risk prevalence. Secondary: influence of malnutrition risk patients' on treatment course and postoperative complications.

RESULTS

533 patients met inclusion criteria and were analyzed. 169 patients (32%) had qualitative risk of malnutrition. The body mass index (BMI) was significantly higher in malnutritioned group, p = 0.001. Albumins in malnutritioned group was 38 g/l (IQR 35-42), whereas in control group it was 41 g/l (IQR 39-43), p = 0.027. Lymphocyte count in malnutrition risk group and control group were 1.24 10'3/μl (IQR 1.1-1.37) and 1.94 10'3/μl (IQR1.7-2.3) respectively, p < 0.001. In linear regression model, a correlation between BMI and total number of lymphocytes was present, p < 0.001. Malnutrition risk did not affect the total morbidity rate. There was a difference in occurrence of postoperative nausea and vomiting, p = 0.033.

CONCLUSIONS

Higher BMI is associated with greater risk of malnutrition. Proper perioperative care may diminish the impact of malnutrition on adverse effects and length of stay (LOS).