Bariatric surgery is effective and safe in patients over 55: a systematic review and meta-analysis.
Effective weight loss and reduction in comorbidities has been convincingly demonstrated with bariatric surgery. Concerns regarding increased perioperative complications and poor results have led to a reluctance to offer such surgery to older patients. We performed a systematic review and meta-analysis of the published evidence for those in the ≥55-year age group. An electronic search was conducted of MEDLINE, EMBASE, and the Cochrane Library databases from 1990 to December 2010. We included laparoscopic studies published in English where the results were broken down by surgical procedure, reporting a minimum 6-month follow-up for ≥10 patients aged ≥55. After an initial screen of 2,543 titles, 298 abstracts were reviewed. Eighteen studies were included in the analysis. Of these, 10 included patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) (663 patients), and 11 included patients undergoing laparoscopic adjustable gastric banding (LAGB) (543 patients). Meta-analyses of body mass index (BMI) reductions indicated sustained and clinically significant BMI reductions for both RYGB (mean percentage of excess weight loss at 1 year, 72.6 %) and LAGB (mean percentage of excess weight loss at 1 year, 39.1 %). The 30-day mortality was 0.30 and 0.18 % for LRYGB and LAGB, respectively. Meta-analysis of old versus young patients revealed better comorbidity and mortality outcomes for younger patients. Bariatric surgery for patients ≥55 years achieves weight loss and reduction in comorbidities and mortality comparable to the general bariatric surgery population. Based on the above findings, patients should not be denied bariatric surgery on the basis of age alone.
Department of Surgery, Frimley Park Hospital, Camberley, Surrey, GU16 7UJ, UK. jeremy.lynch@gmail.com
Jeremy
J
Lynch
Ajay
A
Belgaumkar
D000367:Age Factors; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods*; D015992:Body Mass Index; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D015431:Weight Loss