Background

Whether to offer elderly patients (age > 65 years) metabolic surgery remains controversial. This study aims to better quantify benefits that geriatric patients may expect to derive.

Methods

This retrospective study utilized a database across five bariatric surgery centers in an integrated healthcare delivery system. 415 patients aged 65 or above who underwent sleeve gastrectomy or gastric bypass between 2009-2020 were included. The primary outcome was resolution of obesity at 1-, 3-, 5- and 10-year time points. The secondary outcome was glycemic control after surgery.

Results

The average preoperative BMI for elderly patients undergoing sleeve gastrectomy was 40.8 (n=276). At one year post-op, 33.1% of patients had remission of obesity. However this decreased to 22.0% by 3 years, 18.9% by 5 years and 28.1% at 10 years. The average preoperative BMI for gastric bypass was 40.1 (n=132). At one year post-op, 61.4% of those patients were no longer obese. This decreased to 47.2% at 3 years, 37.6% at 5 years and 51.0% at 10 years. At 10 years, 43.9% of patients who underwent sleeve gastrectomy and 72.5% who underwent gastric bypass maintained >50% excess body weight loss. A higher proportion of elderly patients undergoing gastric bypass were diabetic (HA1c > 6.5%) preop compared to sleeve gastrectomy (41.7% vs 23.9%) and there was a higher trend towards diabetes resolution in patients undergoing gastric bypass though this was not statistically significant (p=0.19).

Conclusions

Metabolic surgery offers a cure for obesity and resolution of associated comorbidities in a subset of geriatric patients.