Department of General and Minimally Invasive Surgery, Poissy/Saint-Germain-en-Laye Medical Center, France.
Department of General and Bariatric Surgery, Al-Amiri Hospital, Kuwait City, Kuwait.
Int J Surg. 2018 Jun;54(Pt A):236-241. doi: 10.1016/j.ijsu.2018.04.050. Epub 2018 May 3.
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.
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.
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.
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.
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.
尽管老年人进行减重手术是安全的，但目前的建议缺乏明确的减重手术适应证，也没有为手术规定上限年龄，这使得手术的选择完全取决于患者的生理年龄和获益风险比，需要进行个体化评估。
数据前瞻性地收集了自 1998 年以来在我们机构接受减重手术的所有患者。79 名年龄大于 60 岁的患者（第 1 组）与 158 名年龄小于 50 岁的患者（第 2 组）匹配，比较两组患者的营养参数。所有纳入的患者在术后 1 年的随访时填写改良的体重对生活质量的影响（IWQOL）问卷。
第 1 组的 69 名患者（87.3%）填写了改良的 IWQOL 问卷。在总共 1860 个答案中，11 个（0.6%）为恶化，64 个（3.4%）为轻度恶化，181 个（9.7%）为轻度改善，1422 个（76.5%）为明显改善。在五个部分中，始终有更多的正面回答而不是负面回答。两组患者术后第 3 个月的血清白蛋白均低于术前值（第 1 组和第 2 组分别为 39.75 对 41.72；p<0.001 和 39.78 对 41.99；p<0.001）。术后 6 个月和 12 个月时，两组患者的血清白蛋白值与术前值相似。两组患者的血清前白蛋白水平分别在术后 12 个月和 6 个月恢复到术前水平。第 1 组在术后 3 个月和 6 个月时的血清前白蛋白水平明显低于第 2 组（0.18 对 0.19；p=0.04 和 0.20 对 0.21；p=0.03），但在术后 1 年时没有差异。
减重手术改善了老年肥胖患者的生活质量，且不影响其营养状况（蛋白质缺乏）。在缺乏明确建议的情况下，这是支持对这些患者进行术前评估的主要依据。为了验证这些发现并确定在跌倒和骨折风险方面的估计优势，还需要进行前瞻性对照研究，进行更复杂的评估和长期随访。
