Pequignot Aurelien, Prevot Flavien, Dhahri Abdennaceur, Rebibo Lionel, Badaoui Rachid, Regimbeau Jean Marc
Departments of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France.
Departments of Anesthesiology, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France.
Surg Obes Relat Dis. 2015 Sep-Oct;11(5):1008-13. doi: 10.1016/j.soard.2014.11.015. Epub 2014 Nov 28.
Current guidelines consider that bariatric surgery is relatively contraindicated in elderly adults (aged≥60 years). The objective of this study was to evaluate obesity-related morbidity after sleeve gastrectomy (SG) according to whether patients were aged≥60 years or<60 years.
Forty-two patients aged≥60 years (the elderly group) were matched 1:2 with 84 patients aged<60 (the control group). The primary objective was to compare weight change and the remission rate of co-morbidities in the 2 groups after 24 months of follow-up. The secondary endpoints were short-term and midterm postoperative outcomes (operating time, the frequency of conversion to laparotomy, the length of hospital stay, postoperative complications, mortality, and the SG failure rate).
No significant differences were observed between the elderly and control groups in terms of the mean operating time (83 minutes in both groups; P = .90), length of stay (3.2 versus 3.4 days, respectively; P = .51), morbidity rate (4.7% versus 9.5%, P = .35), or mortality rate (0% in both groups). The mean excess weight loss was significantly lower in the elderly group than in the control group at 12 months (56.2% versus 71.4%, respectively; P<.01) and 24 months (51.8% versus 73.5%, P<.01). Similar statistically significant differences were observed between the elderly group and control group for remission of metabolic syndrome (95% versus 90%, respectively; P = .55), type 2 diabetes mellitus (87% versus 71%, respectively; P = .13), hypertension (81% versus 77%, respectively; P = .71), and dyslipidemia (94% versus 74%, respectively; P = .09) at 24 months after SG.
Results support the safety and efficacy of SG for morbid obesity in patients aged≥60 years. In contrast to weight loss, the long-term morbidity rate and remission of obesity-related co-morbidities were similar in the participants aged≥60 years and those aged<60 years.
当前指南认为，老年成年人（年龄≥60岁）相对禁忌接受减重手术。本研究的目的是根据患者年龄≥60岁或＜60岁，评估袖状胃切除术（SG）后与肥胖相关的发病率。
42例年龄≥60岁的患者（老年组）与84例年龄＜60岁的患者（对照组）按1:2进行匹配。主要目的是比较两组在随访24个月后的体重变化和合并症缓解率。次要终点是术后短期和中期结局（手术时间、转为开腹手术的频率、住院时间、术后并发症、死亡率和SG失败率）。
老年组和对照组在平均手术时间（两组均为83分钟；P = 0.90）、住院时间（分别为3.2天和3.4天；P = 0.51）、发病率（4.7%对9.5%，P = 0.35）或死亡率（两组均为0%）方面未观察到显著差异。在12个月时（分别为56.2%对71.4%；P＜0.01）和24个月时（51.8%对73.5%，P＜0.01），老年组的平均超重减轻显著低于对照组。在SG术后24个月时，老年组和对照组在代谢综合征缓解（分别为95%对90%；P = 0.55）、2型糖尿病（分别为87%对71%；P = 0.13）、高血压（分别为81%对77%；P = 0.71）和血脂异常（分别为94%对74%；P = 0.09）方面也观察到类似的统计学显著差异。
结果支持SG用于年龄≥60岁的病态肥胖患者的安全性和有效性。与体重减轻不同，年龄≥60岁的参与者与年龄＜60岁的参与者在长期发病率和肥胖相关合并症的缓解方面相似。
