Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Bariatric Surgery

Outcomes of bariatric surgery in elderly patients: a registry-based cohort study with 3-year follow-up

International Journal of Obesity volume 46, pages 574–580 (2022)Cite this article

Subjects

Abstract

Background

Elderly patients undergo bariatric surgery less frequently than younger patients. Short- and medium-term outcomes after bariatric surgery in the elderly population remain largely unknown. The objective of the present retrospective, registry-based cohort study was to compare short- and medium-term outcomes between patients <65 and ≥65 years undergoing bariatric surgery, hypothesizing similar outcomes between groups.

Methods

In this retrospective, registry-based cohort study, the Ontario Bariatric Registry was used to compare data of patients <65 and ≥65 years who underwent Roux-en-Y gastric bypass and sleeve gastrectomy between January 2010 and August 2019 in all accredited bariatric centers of excellence in Ontario, Canada. Primary outcomes were overall postoperative complications. Secondary outcomes included early (<30 days) complications, readmissions, reoperations, mortality, weight loss and comorbidities improvement at 1 and 3 year after surgery.

Results

Data of 22,981 patients <65 and 532 patients ≥65 years were analyzed. Overall postoperative complications were similar between patients <65 and ≥65 years (3388/22,981 [14.7%] vs. 73/532 [13.7%], p = 0.537). Early (<30 days) postoperative complications, readmissions, reoperations, and mortality rates were also similar between groups. Both groups had significant weight loss and comorbidities improvement at 1- and 3-year follow-up. Patients <65 years had superior weight loss (+3.5%, 95% CI: 1.6–5.4, p < 0.001) and higher rates of remission for diabetes mellitus (63.8% vs. 39.3%, p < 0.001), hypertension (37.9% vs. 14.5%, p < 0.001), dyslipidemia (28.2% vs. 9.5%, p < 0.001) and gastroesophageal reflux (65.1% vs. 24.0 %, p < 0.001) compared to patients ≥65 years at 3 year.

Conclusions

Patients <65 and ≥65 years had similar perioperative morbidity and mortality after bariatric surgery. Even though patients <65 years had overall better medium-term outcomes, bariatric surgery is safe and yields significant weight loss and comorbidities improvement in patients ≥65 years.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390:2627–42.

  2. The Organisation for Economic Co-operation and Development (OECD), Obesity Update 2017. Available at: http://www.oecd.org/health/obesity-update.htm. Accessed August 20, 2021.

  3. Buchwald H. Consensus conference panel. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis. 2005;1:371–81.

    Article  Google Scholar 

  4. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  Google Scholar 

  5. English WJ, DeMaria EJ, Hutter MM, Kothari SN, Mattar SG, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2020;16:457–63.

    Article  Google Scholar 

  6. Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28:3783–94.

    Article  Google Scholar 

  7. The World Bank Data, Population age 65 and above. Available at: https://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS?name_desc=false. Accessed August 20, 2021.

  8. Varela JE, Wilson SE, Nguyen NT. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72:865–9.

    Article  Google Scholar 

  9. Koh CY, Inaba CS, Sujatha-Bhaskar S, Nguyen NT. Outcomes of laparoscopic bariatric surgery in the elderly population. Am Surg. 2018;84:1600–03.

    Article  Google Scholar 

  10. Susmallian S, Barnea R, Weiss Y, Raziel A. Outcome of bariatric surgery in older patients. Surg Obes Relat Dis. 2018;14:1705–13.

    Article  Google Scholar 

  11. Prasad J, Vogels E, Dove JT, Wood C, Petrick AT, Parker DM. Is age a real or perceived discriminator for bariatric surgery? A long-term analysis of bariatric surgery in the elderly. Surg Obes Relat Dis. 2019;15:725–31.

    Article  Google Scholar 

  12. Vinan-Vega M, Diaz Vico T, Elli EF. Bariatric surgery in the elderly patient: safety and short-time outcome. a case match Analysis. Obes Surg. 2019;29:1007–11.

    Article  Google Scholar 

  13. Kaplan U, Penner S, Farrokhyar F, Andruszkiewicz N, Breau R, Gmora S, et al. Bariatric surgery in the elderly is associated with similar surgical risks and significant long-term health benefits. Obes Surg. 2018;28:2165–70.

    Article  Google Scholar 

  14. United Nations, Global issues: Ageing. Available at: https://www.un.org/en/sections/issues-depth/ageing/. Accessed August 20, 2021.

  15. The Organisation for Economic Co-operation and Development (OECD), Pensions at a Glance 2019. Available at: https://www.oecd-ilibrary.org/fr/social-issues-migration-health/pensions-at-a-glance-2019_b6d3dcfc-en/. Accessed August 20, 2021.

  16. Chung S, Domino ME, Stearns SC, Popkin BM. Retirement and physical activity: analyses by occupation and wealth. Am J Prev Med. 2009;36:422–8.

    Article  Google Scholar 

  17. Chung S, Domino ME, Stearns SC. The effect of retirement on weight. J Gerontol B Psychol Sci Soc Sci. 2009;64:656–65.

    Article  Google Scholar 

  18. Godard M. Gaining weight through retirement? Results from the SHARE survey. J Health Econ. 2016;;45:27–46.

    Article  Google Scholar 

  19. Brethauer SA, Kim J, el Chaar M, Papasavas P, Eisenberg D, Rogers A, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11:489–506.

    Article  Google Scholar 

  20. Ramirez A, Roy M, Hidalgo JE, Szomstein S, Rosenthal RJ. Outcomes of bariatric surgery in patients >70 years old. Surg Obes Relat Dis. 2012;8:458–62.

    Article  Google Scholar 

  21. Loy JJ, Youn HA, Schwack B, Kurian MS, Fielding GA, Ren-Fielding CJ. Safety and efficacy of laparoscopic adjustable gastric banding in patients aged seventy and older. Surg Obes Relat Dis. 2014;10:284–9.

    Article  Google Scholar 

  22. Wittgrove AC, Martinez T. Laparoscopic gastric bypass in patients 60 years and older: early postoperative morbidity and resolution of comorbidities. Obes Surg. 2009;19:1472–76.

    Article  Google Scholar 

  23. Clough A, Layani L, Shah A, Wheatley L, Taylor C. Laparoscopic gastric banding in over 60s. Obes Surg. 2011;21:10–17.

    Article  Google Scholar 

  24. The Ontario Ministry of Health and Long-Term Care, Ontario Health Insurance Plan (OHIP)—Physician Services— Schedule of Fees from July 2, 2021 (effective October 1, 2021). Available at https://www.health.gov.on.ca/en/pro/programs/ohip/sob/. Accessed October 23, 2021.

  25. Zellmer JD, Mathiason MA, Kallies KJ, Kothari SN. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg. 2014;208:903–10.

    Article  Google Scholar 

  26. Boza C, Gamboa C, Salinas J, Achurra P, Vega A, Pérez G. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: a case-control study and 3 years of follow-up. Surg Obes Relat Dis. 2012;8:243–9.

    Article  Google Scholar 

  27. St-Onge MP, Gallagher D. Body composition changes with aging: the cause or the result of alterations in metabolic rate and macronutrient oxidation? Nutrition. 2010;26:152–5.

    Article  CAS  Google Scholar 

  28. Reinders I, Visser M, Schaap L. Body weight and body composition in old age and their relationship with frailty. Curr Opin Clin Nutr Metab Care. 2017;20:11–15.

    Article  Google Scholar 

  29. Villareal DT, Chode S, Parimi N, Sinacore DR, Hilton T, Armamento-Villareal R, et al. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med. 2011;364:1218–29.

    Article  CAS  Google Scholar 

  30. Svetkey LP, Stevens VJ, Brantley PJ, Appel LJ, Hollis JF, Loria CM, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA. 2008;299:1139–48.

    Article  CAS  Google Scholar 

  31. Coughlin JW, Brantley PJ, Champagne CM, Vollmer WM, Stevens VJ, Funk K, et al. The impact of continued intervention on weight: Five-year results from the weight loss maintenance trial. Obesity (Silver Spring). 2016;24:1046–1053.

    Article  Google Scholar 

  32. Organisation for Economic Co-operation and Development (OECD), Life expectancy at birth. Available at: https://data.oecd.org/healthstat/life-expectancy-at-birth.htm/. Accessed August 20, 2021.

  33. Sanderson WC, Scherbov S. Choosing between the UN’s alternative views of population aging. PLoS One. 2020;15:e0233602.

    Article  CAS  Google Scholar 

  34. Sanderson WC, Scherbov S (eds). Prospective Longevity: A New Vision of Population Aging. Cambridge, MA, USA: Harvard University Press; 2019.

  35. Arterburn DE, Olsen MK, Smith VA, Livingston EH, Van Scoyoc L, Yancy WS Jr, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313:62–70.

    Article  CAS  Google Scholar 

  36. Poole NA, Al Atar A, Kuhanendran D, Bidlake L, Fiennes A, McCluskey S, et al. Compliance with surgical after-care following bariatric surgery for morbid obesity: a retrospective study. Obes Surg. 2005;15:261–5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada

    Pouya Iranmanesh, Vanessa Boudreau, Karim Ramji, Karen Barlow, Olivia Lovrics & Mehran Anvari

  2. Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland

    Pouya Iranmanesh

Authors
  1. Pouya Iranmanesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vanessa Boudreau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karim Ramji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karen Barlow
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Olivia Lovrics
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mehran Anvari
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PI: principal investigator—design and conception of the study, data collection, data analysis, interpretation of data, manuscript drafting. VB: design and conception of the study, interpretation of data, critical revision for important intellectual content. KR: interpretation of data, critical revision for important intellectual content. KB: data collection, data analysis, interpretation of data, critical revision for important intellectual content. OL: data collection, interpretation of data, critical revision for important intellectual content. MA: design and conception of the study, interpretation of data, critical revision for important intellectual content. All authors approve the final version of the manuscript to be published and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors fulfill the four ICMJE criteria for authorship.

Corresponding author

Correspondence to Pouya Iranmanesh.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iranmanesh, P., Boudreau, V., Ramji, K. et al. Outcomes of bariatric surgery in elderly patients: a registry-based cohort study with 3-year follow-up. Int J Obes 46, 574–580 (2022). https://doi.org/10.1038/s41366-021-01031-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-021-01031-w

This article is cited by

Search

Advanced search

Quick links