Older Age increases Risk of Obesity Surgery

People 65 years of age or older may think twice about having weight loss surgery, according to a surgeon who performs this operation and has studied the outcome.

You've got to go into this knowing that the risks are very formidable and you and your family have to be prepared to take those risks," Dr. Edward H. Livingston of the UT Southwestern Medical Center in Dallas told Reuters Health.

In a review of more than 25,000 weight-loss operations, also referred to as bariatric surgery, performed nationwide in 2001 and 2002, Livingston and his colleague Joshua Langert found that complications rose as people aged, and showed a "steep increase" after age 65.

Livingston and Langert used length of hospital stay as a marker for surgical complications, which can include leakage of the stitches used to link together sections of the stomach or intestine; pneumonia; and a type of blood infection known as sepsis.

Among the 1 percent of patients in the study who were 65 or older, 20 percent spent a week or longer in the hospital after surgery, indicating that they experienced adverse events, while 3.2 percent died in the hospital. The researchers also found a greater risk of complications among men, people with electrolyte imbalances, and those with diabetes.

Complications of bariatric surgery also were high among people on Medicaid who were younger than 65, who are generally disabled and likely to be poor. Further analysis found the increased risk was mainly due their greater risk of having complications related to their obesity such as high blood pressure or diabetes.

Ironically, Livingston noted, people with obesity-related conditions have the most to gain from bariatric surgery, but also are more likely to suffer complications from the surgery.

While the study confirms the risks of obesity surgery in older patients and those in worse health, Dr. Clifford W. Deveney of Oregon Health & Science University in Portland notes, "it is not certain when the risks outweigh the potential gains."

He concludes: "We need to look at benefits in the vast majority of patients who survive their bariatric procedure to determine what an appropriate risk is for a given patient. These data will only come from prospective studies designed to assess long-term outcomes following bariatric procedures."

SOURCE: Archives of Surgery, November 2006