Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital & Department of Surgery, Ersta Hospital, Stockholm, Sweden.
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Surg Obes Relat Dis. 2018 Apr;14(4):437-442. doi: 10.1016/j.soard.2017.12.024. Epub 2018 Jan 4.
An increasing number of older patients undergo bariatric surgery.
To define the risk for complications and mortality in relation to age after gastric bypass.
A national registry-based study.
Patients (n = 47,660) undergoing gastric bypass between May 2007 and October 2016 and registered in the Scandinavian Obesity Register were included. Risk between age groups was compared by multivariate analysis.
The 30-day follow-up rate was 98.1%. In the entire cohort of patients, any complication within 30 days was demonstrated in 8.4%. For patients aged 50 to 54, 55 to 59, and ≥60 years, this risk was significantly increased to 9.8%, 10.0%, and 10.2%, respectively. Rates of specific surgical complications, such as anastomotic leak, bleeding, and deep infections/abscesses were all significantly increased by 14% to 41% in patients aged 50 to 54 years, with a small additional, albeit not significant, increase in risk in patients of older age. The risk of medical complications (thromboembolic events, cardiovascular, and pulmonary complications) was significantly increased in patients aged ≥60 years. Mortality was .03% in all patients without differences between groups.
In this large data set, rates of complications and mortality after 30 days were low. For many complications, an increased risk was encountered in patients aged ≥50 years. However, rates of complications and mortality were still acceptably low in these age groups. Taking the expected benefits in terms of weight loss and improvements of co-morbidities into consideration, our findings suggest that patients of older age should be considered for surgery after thorough individual risk assessment rather than denied bariatric surgery based solely on a predefined chronologic age limit.
越来越多的老年患者接受减重手术。
确定胃旁路术后与年龄相关的并发症和死亡率风险。
基于全国注册的研究。
纳入 2007 年 5 月至 2016 年 10 月期间在斯堪的纳维亚肥胖登记处接受胃旁路手术且已登记的患者（n=47660）。通过多变量分析比较各年龄组之间的风险。
30 天随访率为 98.1%。在整个患者队列中，30 天内任何并发症的发生率为 8.4%。对于年龄在 50 至 54 岁、55 至 59 岁和≥60 岁的患者，该风险分别显著增加至 9.8%、10.0%和 10.2%。特定手术并发症的发生率，如吻合口漏、出血和深部感染/脓肿，在 50 至 54 岁的患者中均增加了 14%至 41%，而年龄较大的患者的风险略有增加，但无统计学意义。≥60 岁患者的医疗并发症（血栓栓塞事件、心血管和肺部并发症）风险显著增加。所有患者的死亡率为 0.03%，各组之间无差异。
在这个大型数据集，30 天后的并发症和死亡率发生率较低。对于许多并发症，≥50 岁的患者风险增加。然而，这些年龄组的并发症和死亡率仍然较低，可接受。考虑到在减重和改善合并症方面的预期获益，我们的研究结果表明，对于老年患者，应在进行彻底的个体化风险评估后考虑手术，而不应仅仅基于预定义的年龄限制而拒绝进行减重手术。
