Robert A Casillas1, Benjamin Kim1, Heidi Fischer2, Jorge L Zelada Getty1, Scott S Um1, Karen J Coleman3. 1. Kaiser Permanente Southern California, West Los Angeles Medical Center, Department of Surgery, Los Angeles, California. 2. Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California. 3. Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California. Electronic address: Karen.J.Coleman@kp.org.
Abstract
BACKGROUND: Most bariatric studies in older adult patients have focused on older operations with limited follow-up and equivocal results. OBJECTIVES: To compare weight loss and safety in patients ages≥65 years undergoing laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). SETTING: Nine different bariatric surgery centers with 23 surgeons serving over 30,000 bariatric patients. METHODS: Participants were≥65 years who had a SG or LRYGB between January 1, 2010, and March 15, 2015. Outcomes measured were change in weight up to 4 years after surgery; 30-, 90-, and 365-day mortality; and early (≤30 d) and late (31-365 d) complication rates. To control for nonrandom assignment, SG and LRYGB cases were propensity matched at the time of surgery for gender, race/ethnicity, procedure year, body mass index, presence of diabetes and/or hypertension, and overall co-morbidity burden. RESULTS: There were 177 LRYGB and 252 SG patients (n = 429). Patients were female (70%), 67 years old (range 65 to 79), non-Hispanic white (64%), and had a body mass index of 42.6±5.4 kg/m2. The year 4 follow-up rate was 75% (n = 322). LRYGB patients lost significantly more weight than SG after a median 4 years of follow-up (P<.001), mortality was similar, and LRYGB had higher overall complication rates (30.5%) than SG (15.4%). CONCLUSIONS: Elderly patients lost significantly more weight with LRYGB compared with SG. Further studies will be necessary to determine if the long-term effects of greater weight loss warrant the increased risk involved with LRYGB.
BACKGROUND: Most bariatric studies in older adult patients have focused on older operations with limited follow-up and equivocal results. OBJECTIVES: To compare weight loss and safety in patients ages≥65 years undergoing laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). SETTING: Nine different bariatric surgery centers with 23 surgeons serving over 30,000 bariatric patients. METHODS:Participants were≥65 years who had a SG or LRYGB between January 1, 2010, and March 15, 2015. Outcomes measured were change in weight up to 4 years after surgery; 30-, 90-, and 365-day mortality; and early (≤30 d) and late (31-365 d) complication rates. To control for nonrandom assignment, SG and LRYGB cases were propensity matched at the time of surgery for gender, race/ethnicity, procedure year, body mass index, presence of diabetes and/or hypertension, and overall co-morbidity burden. RESULTS: There were 177 LRYGB and 252 SG patients (n = 429). Patients were female (70%), 67 years old (range 65 to 79), non-Hispanic white (64%), and had a body mass index of 42.6±5.4 kg/m2. The year 4 follow-up rate was 75% (n = 322). LRYGB patients lost significantly more weight than SG after a median 4 years of follow-up (P<.001), mortality was similar, and LRYGB had higher overall complication rates (30.5%) than SG (15.4%). CONCLUSIONS: Elderly patients lost significantly more weight with LRYGB compared with SG. Further studies will be necessary to determine if the long-term effects of greater weight loss warrant the increased risk involved with LRYGB.