Bariatric Surgery Revisions May Be Safe, Effective, in Older Adults

By Lisa Rapaport

May 17, 2021

(Reuters Health) - Bariatric surgery patients older than 65 who undergo revision operations may have similar outcomes to their younger counterparts, a small study suggests.

Researchers examined data on 145 bariatric revisions performed for refractory obesity, including 15 individuals who were over 65 years old. The study didn't identify differences in mortality, comorbidities, or percent of excess weight lost at 12 months based on whether patients were over 65.

While these results suggest that bariatric revisional surgery can be both safe and effective in older adults, larger multi-center studies are still needed to confirm this, the study team writes in the American Journal of Surgery. Lead study author Dr. Torbjorg Holtestaul of Madigan Army Medical Center in Tacoma, Washington, declined to comment on the findings.

"With just 15 patients in the older group, it strikes me as probably underpowered to detect any meaningful differences in outcomes," said Dr. Andrew Ibrahim an assistant professor of surgery, architecture, and urban planning at the University of Michigan, in Ann Arbor.

Some previous research does suggest that older age adds only minimal risk to bariatric surgery - at least for the initial operations, Dr. Ibrahim, who wasn't involved in the study, said by email.

In the current study, researchers didn't find significant differences between age groups in operative time, the proportion of patients who had conversion to sleeve or bypass, or the proportion of patients who had laparoscopic versus open surgery.

Beyond this, researchers also didn't find significant differences in readmissions or postoperative complications, infections, or mortality.

Length of stay, however, was significantly longer for the younger patients (2 days) compared to the older patients (1 day).

The percentage of excess weight lost after revision surgery was significantly lower for patients over 65 (13%) than for those under 65 (25%) at six months after revision surgery. By 12 months, there was no longer a significant difference in weight loss between older (15%) and younger (19%) patients.

Because revision surgery is rare, and only a small proportion of these are done for elderly patients, the review had a limited sample size of older adults, the study team notes. Another limitation of the study is that only 70% of the patients had follow-up outcomes at 12 months.

A much larger data set with long-term follow up of five years or more is needed to more completely and thoroughly address the safety and efficacy of revisional bariatric surgery in older patients, said Dr. Anita Courcoulas, chief of minimally invasive bariatric and general surgery at the University of Pittsburgh Medical Center in Pennsylvania.

Bariatric revision procedures are becoming more common in the U.S. each year, and are typically performed only to address complications resulting from the original operation or to address inadequate weight loss or weight regain, Dr. Courcoulas, who wasn't involved in the study, said by email.

"The results of revisional surgery for weight loss or weight regain, addressed in this paper, need to be studied within the context of a very large multi-center cohort to adequately address the long-term benefits and risks," Dr. Courcoulas said. "Revisional procedures are a very heterogeneous group of procedures, so detailed information about the indications, procedures, and outcomes need to be collected."

SOURCE: American Journal of Surgery, online April 2, 2021.