Evaluation of outcome and safety of bariatric surgery in super-obese elderly patients

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Abstract

Background
Super obesity and old age are risk factors for bariatric complications. However, super-obese elderly (SOE) patients are the most vulnerable for obesity-related complications and the most in-need candidates for bariatric surgery. This study evaluates the safety and outcome of bariatric surgery in SOE patients.
Patients and methods
A retrospective cohort study of patients older than 60 years who underwent bariatric surgery was conducted between January 2015 and June 2018. The study group included patients older than 60 years with BMI more than or equal to 50 kg/m, whereas the control group [morbidly obese elderly (MOE) group] included patients older than 60 years with BMI less than 50 kg/m. Included bariatric procedures were sleeve gastrectomy, one-anastomosis gastric bypass (OAGB), Roux-en-Y gastric bypass, and revisional bariatric surgeries. Outcomes of both groups after bariatric surgery were compared in terms of in-hospital morbidities and mortalities.
Results
Of 99 elderly patients, the SOE group included 60 (60.6%) patients with a mean age of 63.05±2.7 years and mean BMI of 57.97±6.1 kg/m. MOE group included 39 (39.4%) patients with mean BMI of 44.32±4.1 kg/m. A total of 51 (85%) patients underwent laparoscopic sleeve gastrectomy and nine (15%) patients underwent laparoscopic OAGB. Major postoperative complications occurred in six (10.1%) patients with SOE and in two (5.1%, =0.39) patients of the MOE group. There was no hospital mortality among SOE patients, whereas one patient of the MOE group died out of septic shock secondary to anastomotic leak after OAGB. Regarding excess weight loss, there was no significant difference between both groups.
Conclusion
The safety of bariatric surgery in SOE patients is comparable to MOE patients. Judicious perioperative management is important for safety and better outcome.

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