Gastric Bypass is Safe and Effective for Morbidly Obese Elderly

Yael Waknine

July 01, 2005

July 1, 2005 — Gastric bypass surgery is safe and resolves or significantly improves comorbid conditions of morbid obesity in the elderly, according to the results of a retrospective study presented at the 22nd Annual Meeting of the American Society for Bariatric Surgery in Orlando, Florida.

Patients in this population demonstrate an extremely high level of postoperative compliance.

"Life expectancy at [age] 65 [years] is increasing, and cardiac surgery, neurosurgery, and other aggressive treatments have been offered to elderly patients to improve their quality and quantity of life — why not weight loss surgery?," Ricardo Cohen, MD, lead investigator, told Medscape.

Dr. Cohen is director of the Center for the Surgical Treatment of Morbid Obesity at São Camilo Hospital in São Paulo, Brazil.

According to Dr. Cohen, morbidly obese elderly patients who opt for the procedure do so with the intent of resolving life-threatening comorbidities rather than for cosmetic reasons.

"Elderly patients are more mature than young adults — they understand the surgery, are serious about improving their quality and quantity of life, and are extremely adherent to treatment," Dr. Cohen noted.

In the study, investigators evaluated the effects of laparoscopic Roux-en-Y gastric bypass surgery in 108 patients aged 60 years and older (mean age, 66 years; range, 60 - 76 years; two thirds women) with a mean body mass index (BMI) of 44 kg/m2 (range, 38 - 55 kg/m2). Preoperative comorbidities included arthropathy (n = 76), hypertension (HTN; n = 73), diabetes (n = 66), cardiopathy (n = 54), lipid disorders (n = 35), gastroesophageal reflux disease (GERD; n = 19), and sleep apnea (n = 12).

No intraoperative complications occurred and mean hospital stay was 36 hours; no postoperative leaks developed. "If you do a complete preoperative workup and consult with specialists regarding the comorbid conditions, the surgical risks are the same as for younger patients," Dr. Cohen noted.

Postoperative compliance was extremely high; 92.6% of patients continued to follow up regularly with their physician for 48 months compared with 68.8% of younger patients. In addition, 81% of elderly patients continued to exercise regularly.

Excess weight loss was 71% at 12 months, 69% at 24 months, and 67% at 48 months, relative to baseline. "Elderly patients lose about 10% less weight than young adults after gastric bypass, but show more gains in quality of life by curing or significantly improving their comorbidities."

At 48 months, 63%, 77%, and 94% of patients achieved resolution of HTN, diabetes, and lipid disorders, respectively. In addition, 32% of HTN patients presented with more easily controlled disease, 9% of diabetic patients required less medication, and 100% of patients with cardiopathy showed significant improvement in their disease. GERD and sleep apnea were resolved in all patients.

"Elderly patients with morbid obesity are not interested in looking good in bathing suits — they want to stop taking 10 pills a day for comorbid conditions," Dr. Cohen concluded. "They are serious about following instructions and adhering to treatment, and there is no doubt that gastric bypass surgery greatly improves their quality of life."

The investigators report no pertinent financial disclosures.

22nd Annual Meeting ASBS: Oral Presentation. Presented July 1, 2005.

Reviewed by Gary D. Vogin, MD


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