LOS ANGELES — Both seniors and adolescents can be good candidates for Roux-en-Y gastric bypass surgery, according to new research presented at the annual Digestive Disease Week.
In a retrospective analysis of 167 surgical cases at the Mayo Clinic in Rochester, Minn., involving patients aged 60 or older and adolescents aged 12–18 years, researchers found a significant decrease in obesity-related mortality after gastric bypass surgery, and limited morbidity and mortality overall.
The researchers analyzed cases from the Mayo Clinic's 20-year bariatric surgery database and obtained morbidity and mortality rates from medical records. They also sent a questionnaire to all surviving patients.
The older patients had higher rates of adverse events and reported having experienced less dramatic results both in decreases in body mass index (BMI) and self-assessed declines in obesity-related health conditions.
The 155 older patients—aged 60–76 years—had a 6% mortality after 5 years of follow-up, and another 14% had had serious morbidities that delayed their discharge from the hospital follwing surgery, such as wound infections, bowel obstructions, or cardiovascular events.
Patients reported about a 50% reversal in obesity-related comorbidities, and the average BMI was reduced from 46 to 33 kg/m
Mortality for older patients in this study (0.7%) is significantly lower than the rate in a previous report about Medicare patients who underwent gastric bypass surgery, Dr. Sarr said. That study reported a 30-day mortality of nearly 5% in patients aged 65 and older (JAMA 2005;294:1903–8).
“That is just not our experience at the Mayo Clinic,” he said.
But he added that mortality and morbidity post surgery can be high at surgical centers that perform a low volume of these operations, while high-volume centers carry a much lower risk.
Among 12 adolescent patients aged 12–18 years who underwent the surgery, there were no serious adverse events and no deaths after 3 years of follow-up. The overall morbidity was about 10%, Dr. Sarr said.
The adolescent patients had an average drop in BMI of 55 to 36, and patients reported experiencing an 82% reduction in obesity-related diseases.
The need for the surgery in the adolescent population is clear, he said, so the debate now centers on the appropriate operation in this group. For example, some surgeons favor using a gastric band, which can be adjusted or removed, instead of traditional Roux-en-Y gastric bypass surgery. Dr. Sarr said he expects to see more research in this population in the next 3–4 years.