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Age Not a Barrier for Bariatric Surgery: Presented at DDW

By Crystal Phend

LOS ANGELES, C.A. -- May 22, 2006 -- Despite some recent reports to the contrary, gastric bypass surgery is safe and effective in very obese adolescents and elderly individuals when performed at experienced centers, according to a presentation here at Digestive Diseases Week 2006 (DDW).

"It's a fairly radical approach," said senior author Michael G. Sarr, MD, general and gastrointestinal surgeon, Mayo Clinic College of Medicine, Rochester, Minnesota, "but both safe and effective at high-volume centers for patients with morbid obesity at both extremes of age."

The study looked at outcomes of the 155 patients who were at least 60 years old out of a total of 1,786 patients who underwent Roux-en-Y bariatric surgery at Mayo Clinic centers over the last 20 years. Most patients had a body mass index (BMI) of at least 40, classifying them as morbidly obese or "medically-complicated obese."

In this group, the 5-year mortality was about 5%, although "the complication rate was a little bit higher as you might expect," Dr. Sarr said (15%). The 30-day mortality was 0.7% (1 patient).

Serious complications delaying discharge occurred in 14% of older patients, which included 6 wound infections and 1 seroma, 5 bowel obstructions, 3 anastomotic leaks, 4 cardiovascular or respiratory events, and 1 each with renal failure, gastric stasis, and gastrointestinal bleed.

Body mass index (BMI in kg/m²) decreased from a mean of 46 to 33. Slightly more than half of weight-related comorbidities resolved and the subjective overall satisfaction rate was 89%.

The study also looked at all 12 adolescents who received the same bariatric surgery at the centers. Ages ranged from 12 to 18 years. Indications included insulin-resistant diabetes mellitus in 3 patients, sleep apnea in 3 patients, obesity-induced asthma in 3 patients, and prevention of impending weight-related morbidity or psychosocial retardation in 12 patients.

"These kids have bad, bad morbidity," Dr. Sarr said. He also emphasized the importance of psychosocial retardation in morbidly obese adolescents and children.

In this younger group, there were no deaths and no serious comorbidities. Mean BMI decreased from 55 to 36 after an average follow-up of 3 years. Subjectively assessed resolution of weight-related comorbidities was 82%, and patients' satisfaction with outcome was 83%.

"This is going to be a problem that we all have to deal with in the near future -- obesity in our children," Dr. Sarr said.

The average bariatric surgery candidate is 40 years old, he said.


[Presentation title: Bariatric Surgery at the Extremes of Age. Abstract M1549]

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