BARIATRIC SURGERY IN THE ELDERLY: RESULTS OF A MEAN FOLLOW-UP OF FIVE YEARS

Background : Surgical treatment of obesity in the elderly, particularly over 65, remains controversial; it is explained by the increased surgical risk or the lack of data demonstrating its long-term benefit. Few studies have evaluated the clinical effects of bariatric surgery in this population. Aim : To evaluate the results of surgical treatment of obesity in patients over 60 years, followed for an average period of five years. Method : This was a retrospective study evaluating 46 patients, 60 years or older, who underwent surgical treatment of obesity, by conventional gastric bypass technique (laparotomy). The average age was 64 years (60-71), mean BMI of 49.6 kg/m2 (38-66), mean follow-up of 5.9 years; 91% of patients were hypertensive, 56% diabetics and 39% had dyslipidemia. Results : The incidence of complications (major and minor) in patients under 65 years was 26% and over 65 years 37% (p=0.002). There were no deaths in the group with less than 65 years and there were two deaths (12.5%) over 65 years. The average loss of overweight over 65 years or less was 72% vs 68% (p=0.56). There was total control of the diabetes mellitus in 77% and partial in 23%, with no difference between groups. There was improvement in arterial hypertension in 56% of patients, also no difference between groups. The average LDL levels did not differ between the pre and postoperative (106 mg/dl to 102 mg/dl), an increase of HDL (56 mg/dl to 68 mg/dL) and reduced triglyceride levels (136 mg/dl to 109 mg/dl). There was no statistical difference in the variation of the cholesterol fractions and triglycerides between the groups. Two patients in the group with less than 65 years died in late follow-up, of brain tumor and pneumonia, three and five years after bariatric surgery, respectively. Conclusions : Surgical morbidity and mortality were higher in patients over 65 years, and this group had the same benefits observed in patients lower 65 years for weight loss and comorbidities control.

背景：老年（尤其是65岁以上人群）的肥胖外科治疗仍存在争议；该争议源于手术风险升高，以及缺乏证明其长期获益的相关数据。目前针对该人群开展减重代谢手术（bariatric surgery）临床效果评估的研究较少。
研究目的：旨在评估60岁及以上肥胖患者接受外科治疗后的疗效，随访周期平均为5年。
研究方法：本研究为回顾性研究，共纳入46例60岁及以上、接受常规胃旁路术（开腹方式）的肥胖外科治疗患者。受试者平均年龄为64岁（范围60~71岁），平均体质量指数（Body Mass Index, BMI）为49.6 kg/m²（范围38~66 kg/m²），平均随访时长为5.9年；其中91%的患者合并高血压，56%合并糖尿病，39%合并血脂异常。
研究结果：65岁以下患者的并发症（含严重与轻微并发症）发生率为26%，65岁及以上患者为37%（p=0.002）。65岁以下组无死亡病例，而65岁及以上组有2例死亡，占比12.5%。65岁及以上与65岁以下患者的超重体重平均降幅分别为72%与68%（p=0.56），组间无显著差异。糖尿病完全控制率为77%，部分控制率为23%，两组间无差异。56%的患者高血压症状得到改善，组间同样无显著差异。术前与术后的低密度脂蛋白（Low-Density Lipoprotein, LDL）水平无显著差异（106 mg/dl 降至102 mg/dl），高密度脂蛋白（High-Density Lipoprotein, HDL）水平有所升高（56 mg/dl 升至68 mg/dL），甘油三酯水平则有所降低（136 mg/dl 降至109 mg/dl）。两组间血脂各组分及甘油三酯的变化幅度均无统计学差异。65岁以下组有2例患者在术后晚期随访中死亡，分别死于脑肿瘤与肺炎，距减重代谢手术时间分别为3年与5年。
研究结论：65岁及以上患者的手术并发症发生率与死亡率均更高，但该组患者在减重效果与合并症控制方面的获益与65岁以下患者并无差异。