Seniors more at risk for complications, death from large scale weight-loss surgery

The first large-scale review of weight-loss surgeries performed on older adults suggests bariatric procedures should generally be limited to people younger than age 65, researchers at UT Southwestern Medical Center have found.

The study showed that older patients experienced less weight loss and far more complications than younger patients, indicating that the risks often outweigh the benefits of these types of surgeries in older patients. The study, which appears in the Archives of Surgery, reviewed more than 25,000 bariatric procedures from a national database.

"Adverse outcomes increased with age, particularly after age 60," said Dr. Edward Livingston, chairman of GI/endocrine surgery at UT Southwestern and the study's lead author. "Beyond 65 years of age, the adverse event rate exceeded 20 percent and mortality was 3.23 percent."

In addition to age, the study found that men and those with electrolyte disorders and congestive heart failure were at greater risk of death from bariatric surgery or related complications, said Dr. Livingston.

Other conditions that increased risk for adverse events and required longer hospital stays included chronic pulmonary disease, diabetes and depression.

Common complications included gastrointestinal, respiratory and cardiac problems. Gastrointestinal problems were most common, occurring in about 30 percent of older patients who had complications. Respiratory-tract problems occurred in about 20 percent of patients with post-operative problems. Cardiac complications affected about 15 percent of elderly patients.

The Centers for Disease Control and Prevention estimates that nearly one-third of adult Americans - more than 60 million people - are obese. Nearly 5 percent of adults are classified as extremely obese. The American Society for Bariatric Surgery Foundation estimates that more than 1,000 people die each day from obesity-related complications. Obese adults are at increased risk of diabetes, hypertension, stroke and even some cancers.

Obesity ranges from mild (20 to 50 pounds overweight) to morbidly obese (more than 100 pounds overweight). Bariatric surgeries are usually reserved for those more than 100 pounds overweight.

This latest study reviewed 25,428 bariatric procedures involving Medicare beneficiaries using the National Inpatient Survey database, which contains discharge information for 20 percent of all hospitalizations in the United States, a sufficiently large enough population to overcome limitations of previous studies.

UT Southwestern is one of the few institutions in the nation that offers all types of bariatric procedures and is a regional referral center and leader in bariatric surgery, having performed the area's first lap band procedures and robotically assisted lap band procedures. UT Southwestern bariatrics programs have garnered national recognition as well, being named bariatric surgery Centers of Excellence by the American Society for Bariatric Surgery and United Resource Networks' Clinical Sciences Institute.