title: Laparoscopic sleeve gastrectomy in patients over 60 years: impact of age on weight loss and co-morbidity improvement.
abstract: BACKGROUND
  Advanced age has traditionally been considered a relative contraindication to bariatric surgery due to increased perioperative risk and less weight loss. However, it is now being reconsidered in older patients after encouraging results in recent series and the increasing life expectancy. We compared operative and postoperative outcomes of laparoscopic sleeve gastrectomy in patients over 60 years with outcomes in younger patients. We also, analyzed the effect of bariatric surgery on improvement and resolution of co-morbidities in the older group.
  
  
  METHODS
  From November 2008 to November 2013, 130 patients underwent laparoscopic sleeve gastrectomy. Of these, 28 patients (21.5%) were 60 years or older. Outcomes in terms of perioperative complications, short-term and medium-term weight loss, remission or improvement of co-morbidities and medication requirements were extracted from our prospective database.
  
  
  RESULTS
  Short-term mortality was 0% and 30-day complication rate was similar in both groups (17.9% versus 17.6% according to Clavien-Dindo classification). At 12 months postsurgery, older patients had lost 49% percent of excess weight compared to 60% in the younger group (P = 0.012). At 2 years, the results were 45% versus 60%, respectively, with P = 0.015. At least 1 major co-morbidity improved in 65.2% of older patients. Before surgery, the older group took an average of 4.3 medications compared to 2.7 at 1 year after surgery (P<0.001).
  
  
  CONCLUSIONS
  Laparoscopic sleeve gastrectomy is a safe and effective treatment for morbid obesity in people over 60 years, although younger patients show greater weight loss. Daily medication requirements and co-morbidities decrease significantly in older patients after this procedure.
authors.affiliation: General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain. Electronic address: crodriguezlu@santpau.cat.
authors.forename: Carlos Rodríguez-Otero
authors.initials: CR
authors.lastname: Luppi
authors.affiliation: General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Balagué
authors.affiliation: General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain.
authors.forename: Eduard M
authors.initials: EM
authors.lastname: Targarona
authors.affiliation: General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain.
authors.forename: Sorin
authors.initials: S
authors.lastname: Mocanu
authors.affiliation: General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Bollo
authors.affiliation: General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Martínez
authors.affiliation: General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Trias
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
keywords: Bariatric surgery; Co-morbidities improvement; Morbid obesity; Older patients; Sleeve gastrectomy; Weight loss