Bariatric surgery risks similar in old and young.
In February, the Centers for Medicare and Medicaid Services extended coverage for bariatric surgery to beneficiaries of all ages, provided that the surgery was per, formed at certified facilities.
And although a recent review of Medicare beneficiaries reported significantly higher mortality in patients aged 65 years and older than in younger patients (JAMA 2005;294:1903-8), the new studies do not support that finding.
In a study of 340 Medicare patients who underwent bariatric surgery, individuals aged 65 years and older had similar rates of major and minor complications but lower mortality after surgery than did those younger than 65 years, reported Dr. David A. Provost of the University of Texas Southwestern Medical Center, Dallas.
No deaths occurred in 65 older adult patients who received either laparoscopic adjustable gastric banding (LAGB) or open or laparoscopic Roux-en-Y gastric bypass (RYGB), but 3 (0.1%) of 275 younger patients died. The overall complication rate for patients aged 65 years and older was similar to that observed for patients under 65 years of age.
In a separate retrospective study of 55 patients aged at least 60 years, laparoscopic bariatric procedures caused no deaths and few complications, reported Dr. David Hazzan of the division of minimally invasive surgery at Mount Sinai School of Medicine, New York.
In the first 30 days after surgery, 4 (7%) patients developed complications: upper GI bleeding, an empyema, a urinary tract infection, and a wound infection. No patients had died at 90 days after surgery.
All patients underwent a contrast swallow study on the first day after surgery, and more than 70% were monitored in the surgical or postanesthesia ICU for the first 24 hours after surgery, based on their comorbidities and cardiovascular status.
Another study found that RYGB surgery in patients aged 60 years and older could be safe and effective in resolving comorbidities, even though the older patients lost less excess weight and had more comorbidities than their younger counterparts.
Of 1,002 patients who received bariatric surgery at the Geisinger Medical Center, Danville, Pa., during 2001-2005, 61 patients aged at least 60 years (mean, 62 years old) and 941 younger patients (mean, 43 years old) received laparoscopic or open RYGB surgery, said Dr. Stephanie E. Dunkle-Blatter, of the center.
Surgeons performed laparoscopic RYGB surgery in 32% of the older patients and in 53% of the younger patients. Postoperative body mass index was similar between the two groups (about 36 kg/[m.sup.2]), despite a larger percentage of excess weight lost in younger patients (53% vs. 46%). At a mean follow-up of nearly 14 months in older patients and almost 17 months in younger patients, a significantly greater percentage of older patients resolved or improved their type 2 diabetes than did younger patients (98% vs. 91%), but a significantly larger percentage of younger patients had improvement or resolution of hypertension than did older patients (83% vs. 76%). The number of prescription medications decreased from about 10 to 5 in older adults and from about 5 to 3 in younger patients.
Rates of major complications were 13% in older adults and 12% in younger patients, while rates of minor complications were 27% and 21%, respectively. However, 90-day mortality rates were similar in the two groups (1.6% vs. 0.53%, respectively).
More bariatric surgery is likely to be performed in older adults in the future, given the aging population and climbing rate of obesity, several speakers noted.
BY JEFF EVANS
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|Title Annotation:||Geriatric Medicine|
|Publication:||Family Practice News|
|Date:||Aug 15, 2006|
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