Safety of Sleeve Gastrectomy and Gastric Bypass in Elderly Patients

Complication rates from bariatric surgery, specifically sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB), are low in elderly patients, according to study results published in Surgery for Obesity and Related Diseases. In addition, results indicated a greater safety profile for SG compared with RYGB.

As there are no studies comparing perioperative outcomes, complications, and mortality associated with SG and RYGB in elderly patients, the goal of this study was to compare the safety of the 2 bariatric procedures in patients age >65 years with that in younger patients.

The researchers used the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 to 2017 database to identify nonrevisional laparoscopic RYGB and SG bariatric procedures. Propensity-score matching was based on 3 scenarios including (1) age 18 to 65 vs >65 for SG (13,422 matched pairs), (2) age 18 to 65 vs >65 for RYGB (5395 matched pairs), and (3) SG vs RYGB for elderly patients (5395 matched pairs).

In the SG group, elderly patients had a higher risk for any complication (risk difference [RD], 1.01%; 95% CI, 0.59%-1.43%; P <.0001), >2 days to discharge after surgery (RD, 4.86%; 95% CI, 3.67%-6.05%; P <.0001), and mortality (RD, 0.14%; 95% CI, 0.05%-0.24%; P =.0054) compared with younger patients. There were no differences for 30-day reoperation, readmission, reintervention, or leak rate.

In the RYGB group, elderly patients had a higher risk for >2 days to discharge after surgery (RD, 3.9%; 95% CI, 1.67%-5.1%; P <.0001). However, no differences were noted regarding complications, reoperation, readmission, reintervention, leak, or mortality.

In elderly patients, RYGB was associated with a higher risk for 30-day complications, reoperations, readmission, reinterventions, leaks, and >2 days to discharge after surgery. Mortality risk was not different between the 2 procedures.

The study had several limitations, mainly related to its retrospective design and possible selection bias given lower frequency of bariatric procedures in older patients.

“SG appears to have a favorable safety profile in patients older than 65 as compared to RYGB. The overall complication rate for RYGB is not significantly different between the older and younger groups,” concluded the researchers.

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Reference

Goldberg I, Yang J, Nie L, et al. Safety of bariatric surgery in patients older than 65 years [published online May 18, 2019]. Surg Obes Relat Dis. doi:10.1016/j.soard.2019.05.016