Bariatric surgery in obese older people: useful or not?

ObjectiveThe aim of this study was to determine whether older (≥65 years) obese people would benefit from bariatric surgery, considering the prevalence of multiple comorbidities and frailty in this group. MethodsA PubMed search was carried out for studies on the use of bariatric surgery in older obese people published in the database from 1980 to the present (August 2014). ResultsA total of 244 citations were obtained on searching; 182 of these publications were selected for manual checking and 10 studies were identified as containing useable data on this patient cohort. Published data were available for efficacy in 641 patients. Substantial improvement was observed in diabetes (76%), hypertension (68%) and sleep apnoea (67%) following bariatric surgery. Laparoscopic adjustable gastric banding (n=456) was the most frequently reported procedure. Similar findings but with greater weight loss and fewer complications were found in the small numbers of patients undergoing other procedures. Data from four large registry studies (n=6837) showed mortality and complications associated with bariatric surgery to be increased in older compared with younger people especially in those undergoing gastric bypass surgery. The elderly had longer hospital stays, and patients with cardiac, pulmonary or renal comorbidities generally had a worse prognosis. ConclusionBariatric surgery in older people is effective in reducing complications of obesity, but is also associated with increased rates of complications compared with those seen in younger patients. The few reported studies in the elderly are retrospective, generally small, primarily describe findings of laparoscopic adjustable gastric banding as the surgical intervention option and lack long-term follow-up. More trials and registry data, especially for sleeve gastrectomy and gastric bypass, are required to better address the utility of bariatric surgery in the elderly and to define long-term clinical outcomes.