Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA.
Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, University of Maryland Medical Systems, Baltimore, MD, USA.
Surg Endosc. 2021 Jun;35(6):3139-3146. doi: 10.1007/s00464-020-07752-9. Epub 2020 Jun 29.
Obesity and its associated comorbidities represent a pervasive problem in the United States across all age groups. There are conflicting data regarding the effectiveness and postoperative recovery of bariatric surgery in elderly patients. The aim of this study was to compare outcomes of bariatric surgery across age groups.
After obtaining institutional review board approval, patients with morbid obesity who underwent non-revisional laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) at our institution between 2011 and 2015 were included in this retrospective study. Patients were subdivided into five age groups: < 30, 30-39, 40-49, 50-59, and ≥ 60 years. Patient baseline demographics and comorbidities were collected. Postoperative outcomes including reinterventions/reoperations, 30-day-readmissions, 90-day-mortality, comorbidities' resolution, and change in BMI (ΔBMI) up to 4 years were recorded and compared. The groups were compared with ANOVA and chi-square tests and multivariable analyses.
LRYGB was performed in 74.7% of the 1026 study patients. Patients ≥ 60 years old demonstrated lower preoperative BMI than patients < 50 years (p < 0.001). Patients 50-59 years old had increased length of stay compared to 30-39 (p = 0.003) and a higher prevalence of all comorbidities was found in older patients (p < 0.001). There was no significant difference in 30-day-readmissions; 90-day-mortality; reoperations; and reinterventions among the study groups. The ΔBMI was higher in younger patients and comorbidity resolution was more likely in younger patients with the exception of obstructive sleep apnea.
Bariatric surgery can be accomplished safely across all age groups with satisfiable postoperative weight loss. However, older age had higher hospital stay and convalescence and lower comorbidity resolution compared to younger patients. Thus, bariatric surgery should be offered earlier in life to allow the patients to reap its benefits.
肥胖及其相关合并症在美国各年龄段人群中普遍存在。关于老年患者行减重手术的有效性和术后恢复情况，目前数据存在争议。本研究旨在比较不同年龄段患者减重手术的结果。
在获得机构审查委员会批准后，回顾性分析了 2011 年至 2015 年期间在我院行非再手术腹腔镜 Roux-en-Y 胃旁路术（LRYGB）和袖状胃切除术（LSG）的病态肥胖患者。患者被分为五组：<30 岁、30-39 岁、40-49 岁、50-59 岁和≥60 岁。收集患者的基线人口统计学和合并症数据。记录并比较术后结果，包括再次手术/操作、30 天再入院、90 天死亡率、合并症缓解情况以及 4 年内 BMI 的变化（ΔBMI）。采用方差分析和卡方检验以及多变量分析比较各组之间的差异。
1026 例研究患者中，74.7%行 LRYGB 术。≥60 岁患者的术前 BMI 低于<50 岁患者（p<0.001）。50-59 岁患者的住院时间长于 30-39 岁患者（p=0.003），并且老年患者的所有合并症患病率更高（p<0.001）。各组间 30 天再入院率、90 天死亡率、再次手术/操作率和再次干预率无显著差异。年轻患者的ΔBMI 更高，年轻患者的合并症缓解率更高，除阻塞性睡眠呼吸暂停外。
在所有年龄段均可安全完成减重手术，且术后减重效果令人满意。然而，与年轻患者相比，老年患者的住院时间和康复时间更长，合并症缓解率更低。因此，应更早地为患者提供减重手术，让他们从中受益。
