Koh Christina Y, Inaba Colette S, Sujatha-Bhaskar Sarath, Nguyen Ninh T
Department of Surgery, University of California Irvine Medical Center, 333 City Building, West, Suite 1600, Orange, CA 92868, USA.
Am Surg. 2018 Oct 1;84(10):1600-1603.
There have been limited data on the safety of laparoscopic bariatric surgery in the elderly. To compare outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) between elderly (≥65 years) and nonelderly (18-64 years) patients. Using the 2011 to 2015 NSQIP database, we analyzed severely obese patients who underwent LRYGB or LSG. Univariate and multivariate analyses were performed to assess primary outcomes including 30-day mortality, serious morbidity, length of stay, and readmission. There were 41,475 LRYGB cases performed, including 2,010 (4.8%) cases in elderly patients. Compared with the nonelderly, elderly patients who underwent LRYGB had higher serious morbidity [odds ratio (OR) = 1.43, confidence interval (CI) = 1.16-1.76, = 0.001], but similar 30-day mortality (OR = 0.8, CI = 0.28-2.34, = 0.688). There were 44,550 LSG cases performed, including 2,055 (4.6%) cases in elderly patients. Compared with the nonelderly, elderly patients who underwent LSG had significantly higher serious morbidity (OR = 1.44, CI = 1.12-1.84, = 0.005) and higher 30-day mortality (OR = 3.62, CI = 1.34-9.83, = 0.011). Laparoscopic bariatric surgery is safe in the elderly population, and is similar between bariatric procedures. However, elderly patients have higher serious morbidity; therefore, they should be counseled regarding their higher risk, but should not be denied bariatric surgery based solely on their age.
关于老年患者腹腔镜减肥手术安全性的数据有限。为比较老年（≥65岁）和非老年（18 - 64岁）患者腹腔镜Roux - en - Y胃旁路术（LRYGB）和腹腔镜袖状胃切除术（LSG）的手术结果。利用2011年至2015年的NSQIP数据库，我们分析了接受LRYGB或LSG的严重肥胖患者。进行单因素和多因素分析以评估主要结局，包括30天死亡率、严重并发症、住院时间和再入院情况。共进行了41475例LRYGB手术，其中老年患者2010例（4.8%）。与非老年患者相比，接受LRYGB的老年患者严重并发症发生率更高[比值比（OR）= 1.43，置信区间（CI）= 1.16 - 1.76，P = 0.001]，但30天死亡率相似（OR = 0.8，CI = 0.28 - 2.34，P = 0.688）。共进行了44550例LSG手术，其中老年患者2055例（4.6%）。与非老年患者相比，接受LSG的老年患者严重并发症发生率显著更高（OR = 1.44，CI = 1.12 - 1.84，P = 0.005），30天死亡率也更高（OR = 3.62，CI = 1.34 - 9.83，P = 0.011）。腹腔镜减肥手术在老年人群中是安全的，且不同减肥手术之间相似。然而，老年患者严重并发症发生率更高；因此，应向他们告知其较高的风险，但不应仅因其年龄而拒绝为其实施减肥手术。
