Elie Chouillard1, Salman Alsabah2, Elias Chahine1, Elias Saikaly1, Tarek Debs3, Radwan Kassir4. 1. Department of General and Minimally Invasive Surgery, Poissy/Saint-Germain-en-Laye Medical Center, France. 2. Department of General and Bariatric Surgery, Al-Amiri Hospital, Kuwait City, Kuwait. 3. Department of General Surgery, CHU de l'archet, Nice, France. 4. Department of Digestve Surgery, CHU Félix Guyon, La réunion, Saint Denis, France. Electronic address: radwankassir42@hotmail.Fr.
Abstract
PURPOSE: Bariatric surgery is being safely performed in elderly patients. However, current recommendations lack precise indications for bariatric surgery and fail to define an upper age limit for surgical procedure, leaving the field wide open to case by case assessment according to patient's physiological age and benefit-to-risk balance. OBJECTIVES: The aim of this study is to evaluate the quality of life of obese patients older than 60 years one year after bariatric surgery, and to compare the variation of their nutritional parameters to those of matched younger patients. METHODS: and methods. Data were prospectively collected for all patients who underwent bariatric surgery at our institution starting 1998. Seventy-nine patients older than 60 years (Group1) were matched 1:2 with 158 patients younger than 50 years (Group 2) for comparison of nutritional parameters. A modified Impact of Weight on Quality Of Life (IWQOL) questionnaire was filled by all included patients, at the one-year check-up. RESULTS: The modified IWQOL questionnaire was filled by 69 patients (87.3%). Of a total of 1860 answers, 11 (0.6%) were marked worsening, 64 (3.4%) were mild worsening, 181 (9.7%) were mild improvement, and 1422 (76.5%) were marked improvement. There were more positive answers than negative ones consistently within the five sections. In both groups, mean serum albumin were lower at the third postoperative month than the preoperative values (39.75 versus 41.72; p < 0.001 and 39.78 versus 41.99; p < 0.001 in Groups 1 and 2, respectively). At 6 and 12 months, in both groups, these values were similar to those of the preoperative period. The serum prealbumin levels reached back the preoperative values at 12 and 6 months, respectively, in Groups 1 and 2. Values were significantly lower in Group1 compared to Group 2 at three and six months (0.18 versus 0.19; p = 0.04 and 0.20 versus 0.21; p = 0.03, respectively) but not at one year. CONCLUSIONS: Bariatric surgery improves quality of life in elderly obese patients with no compromise on their nutritional status (protein deficiencies). In the lack of precise recommendations, this represents a major argument that may serve to the preoperative assessment of such patients. More complex evaluations in a prospective controlled studies with long-term follow-up are mandatory to validate these findings and precise the estimated advantage in terms of risks of fall and fracture.
PURPOSE: Bariatric surgery is being safely performed in elderly patients. However, current recommendations lack precise indications for bariatric surgery and fail to define an upper age limit for surgical procedure, leaving the field wide open to case by case assessment according to patient's physiological age and benefit-to-risk balance. OBJECTIVES: The aim of this study is to evaluate the quality of life of obesepatients older than 60 years one year after bariatric surgery, and to compare the variation of their nutritional parameters to those of matched younger patients. METHODS: and methods. Data were prospectively collected for all patients who underwent bariatric surgery at our institution starting 1998. Seventy-nine patients older than 60 years (Group1) were matched 1:2 with 158 patients younger than 50 years (Group 2) for comparison of nutritional parameters. A modified Impact of Weight on Quality Of Life (IWQOL) questionnaire was filled by all included patients, at the one-year check-up. RESULTS: The modified IWQOL questionnaire was filled by 69 patients (87.3%). Of a total of 1860 answers, 11 (0.6%) were marked worsening, 64 (3.4%) were mild worsening, 181 (9.7%) were mild improvement, and 1422 (76.5%) were marked improvement. There were more positive answers than negative ones consistently within the five sections. In both groups, mean serum albumin were lower at the third postoperative month than the preoperative values (39.75 versus 41.72; p < 0.001 and 39.78 versus 41.99; p < 0.001 in Groups 1 and 2, respectively). At 6 and 12 months, in both groups, these values were similar to those of the preoperative period. The serum prealbumin levels reached back the preoperative values at 12 and 6 months, respectively, in Groups 1 and 2. Values were significantly lower in Group1 compared to Group 2 at three and six months (0.18 versus 0.19; p = 0.04 and 0.20 versus 0.21; p = 0.03, respectively) but not at one year. CONCLUSIONS: Bariatric surgery improves quality of life in elderly obesepatients with no compromise on their nutritional status (protein deficiencies). In the lack of precise recommendations, this represents a major argument that may serve to the preoperative assessment of such patients. More complex evaluations in a prospective controlled studies with long-term follow-up are mandatory to validate these findings and precise the estimated advantage in terms of risks of fall and fracture.