title: Outcomes of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Patients Older than 60.
abstract: BACKGROUND
  The proportion of population older than 60 years is rapidly increasing. The majority of this older population suffers from multiple comorbid conditions including obesity. Non-surgical means of weight loss do not offer a predictable solution. Surgical interventions seem to be the most promising solution for the obesity problem, but there is a relative lack of data in literature regarding bariatric procedures in older populations.
  
  
  OBJECTIVE
  Our study aims to evaluate the safety and efficacy of bariatric surgery in patients older than 60 years of age, to determine the weight loss, rate of operation-related complications, and impacts of surgery on comorbid conditions, and to compare the effectiveness of bariatric surgery in older patients to the effectiveness of bariatric surgery for the general population at Montefiore Medical Center.
  
  
  METHODS
  A retrospective review of patients' medical records were used to collect data to create databases to identify patients older than 60 years age who underwent bariatric surgery procedures spanning a 4-year period between January 2009 and October 2013. Data reviewed included age, sex, height, pre-operative weight, and body mass index (BMI), presence of obesity-related comorbid conditions, procedures performed, mortality, immediate or delayed complications, length of follow-up, excess weight lost, BMI points lost, percent of excess weight loss (%EWL), hemoglobin Alc (HgbA1c), and effects on obesity-related comorbid conditions. The percent of excess weight loss and number of complications within the older patient group were compared to the general population, which consists of patients between the ages of 22 and 59.
  
  
  RESULTS
  Ninety-eight patients were identified. Seven patients did not follow up at any time period, and the eight patients who had laparoscopic adjustable gastric band (LAGB) were also excluded due to insufficient data. Overall, 83 patients who were above the age of 60 were examined; 30 patients had laparoscopic sleeve gastrectomy (LSG), and 53 patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). The average patient age was 63.4 years, the average pre-operative weight was 122.3 kg, and the average excess body weight was 54.8 kg. The pre-existing comorbid conditions included 90.4 % hypertension (HTN), 63.9 % diabetes mellitus (DM), 50.6 % hyperlipidemia (HL), 34.9 % obstructive sleep apnea (OSA), and 30.1 % asthma. The average %EWL at 3 months, 6 months, and 12 months was 37.0, 51.3, and 65.2 %, respectively. A significant proportion of patients reported resolution or improvement in comorbid conditions. When results were compared to the general, population there was no significant difference in the number of complications that occurred within each of the two groups. The difference in %EWL at the 12-month follow-up was not statistically significant between the general population and the older patients, which suggests that both groups lost a similar amount of weight and that bariatric surgery on patients who are above the age of 60 is effective.
  
  
  CONCLUSIONS
  Bariatric surgery can be safe and effective for patients older than 60 years of age with a low morbidity and mortality; the weight loss and improvement in comorbidities in older patients were clinically significant. When compared to the general population, there was no statistically significant difference in the average %EWL at 12 months or the number of complications due to surgery. Long-term effects of such interventions will need further studies and investigations.
authors.affiliation: Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. mabbas@montefiore.org.|Department of Surgery, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. mabbas@montefiore.org.
authors.forename: Mujjahid
authors.initials: M
authors.lastname: Abbas
authors.affiliation: Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. lcumella@montefiore.org.|Department of Surgery, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. lcumella@montefiore.org.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Cumella
authors.affiliation: Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. yang.zhang@med.einstein.yu.edu.|Department of Surgery, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. yang.zhang@med.einstein.yu.edu.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. jechoi@montefiore.org.|Department of Surgery, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. jechoi@montefiore.org.
authors.forename: Jenny
authors.initials: J
authors.lastname: Choi
authors.affiliation: Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. pvemulpa@montefiore.org.|Department of Surgery, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. pvemulpa@montefiore.org.
authors.forename: Pratibha
authors.initials: P
authors.lastname: Vemulapalli
authors.affiliation: Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. wsmelvin@montefiore.org.|Department of Surgery, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. wsmelvin@montefiore.org.
authors.forename: W Scott
authors.initials: WS
authors.lastname: Melvin
authors.affiliation: Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. dicamach@montefiore.org.|Department of Surgery, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA. dicamach@montefiore.org.
authors.forename: Diego
authors.initials: D
authors.lastname: Camacho
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000706:statistics & numerical data; D015390:Gastric Bypass / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
keywords: Asthma; Bariatric surgery; Diabetes mellitus; Hemoglobin A1c; Hyperlipidemia; Hypertension; Laparoscopic Roux-en-Y gastric bypass; Laparoscopic sleeve gastrectomy; Morbid obesity; Obstructive sleep apnea; Older patients