title: Incidence and outcomes after bariatric surgery in older patients: a state-wide data-linked cohort study.
abstract: BACKGROUND
  The burgeoning problem of obesity is seen most profoundly in older populations. Despite the dramatic increase in bariatric surgery rates over the last 20 years, weight reduction surgery is largely restricted to younger patients.
  
  
  METHODS
  This retrospective, longitudinal, self-matched, population-based cohort study assessed the incidence and outcomes of all patients undergoing bariatric surgery who were ≥55 years old in Western Australia between 2007 and 2011. The mean preoperative and post-operative follow-up periods were 2.5 years and 3.4 years, respectively.
  
  
  RESULTS
  Of the 12 062 bariatric surgical operations recorded during the study period, 2179 (18.1%) were performed in patients aged ≥55 years old. Older bariatric patients were statistically more likely to require longer hospital admissions (2.85 versus 2.65 days, P < 0.001), have post-operative complications (12.0 versus 6.3%, P < 0.001) and require intensive care admissions (8.2 versus 4.3%, P = 0.001) compared to patients <55 years old. However, both 30-day (no deaths in the older cohort) and long-term mortality rates (1.07 versus 0.42 deaths per 1000 patient-years, P = 0.10) remained relatively low. All-cause long-term hospitalization rates were also significantly reduced (P < 0.001) after bariatric surgery for patients who were older than 55 years compared to before surgery.
  
  
  CONCLUSIONS
  Despite older age being associated with a higher risk of complications and longer hospital stays, there was a reduction in subsequent overall hospitalizations for older patients after bariatric surgery, suggesting that bariatric surgery may still confer health benefits to carefully selected obese older patients who cannot achieve weight loss by other means.
authors.affiliation: Department of Intensive Care Medicine, St John of God Hospital Subiaco, Perth, Western Australia, Australia.
authors.forename: David J R
authors.identifier: http://orcid.org/0000-0002-7410-6591
authors.initials: DJR
authors.lastname: Morgan
authors.affiliation: Department of Intensive Care Medicine, St John of God Hospital Subiaco, Perth, Western Australia, Australia.|School of Population Health, The University of Western Australia, Perth, Western Australia, Australia.|School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia.
authors.forename: Kwok Ming
authors.initials: KM
authors.lastname: Ho
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009765:Obesity / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D014904:Western Australia / Q000453:epidemiology
keywords: age groups; aged; healthcare delivery; obesity; outcomes