Comparative effectiveness of sleeve gastrectomy vs. Roux-en-Y gastric bypass for weight loss and safety outcomes in older adults

• Published in: Surgery for obesity and related diseases
• Main Authors: Casillas, Robert A., MD, Fischer, Heidi, PhD, Kim, Benjamin, MD, Zelada Getty, Jorge L., MD, Um, Scott S., MD, Coleman, Karen J., PhD
• Format: Journal Article
• Language: English
• Published: 2017
• Subjects: Gastroenterology and Hepatology; Surgery
• ISSN: 1550-7289
• DOI: 10.1016/j.soard.2017.03.011

Abstract Background Most bariatric studies in older adult patients have focused on older operations with limited follow-up and equivocal results. Objectives To compare weight loss and safety in patients > 65 years of age undergoing laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (LRYGB). Setting Nine different bariatric surgery centers with 23 surgeons serving over 30,000 bariatric patients. Methods Participants were > 65 years who had a SG or LRYGB between 1/1/2010 and 3/15/2015. Outcomes measured were change in weight up to four years after surgery; 30-, 90-, and 365-day mortality; and early ( < 30 days) and late (31 – 365 days) complication rates. To control for non-random assignment, SG and LRYGB cases were propensity matched at the time of surgery for gender, race/ethnicity, procedure year, body mass index (BMI), presence of diabetes and/or hypertension, and overall comorbidity burden. Results There were 177 LRYGB and 252 SG patients (n = 429). Patients were female (70%), 67 years old (range 65 to 79), non-Hispanic white (64%), and had a BMI of 42.6 + 5.4 kg/m2 . The year 4 follow-up rate was 75% (n = 322). LRYGB patients lost significantly more weight than SG after a median four years of follow-up (p < .001), mortality was similar, and LRYGB had higher overall complication rates (30.5%) than SG (15.4%). Conclusions Elderly patients lost significantly more weight with LRYGB when compared to SG. Further studies will be necessary to determine if the long-term effects of greater weight loss warrant the increased risk involved with LRYGB.