LAWLS Bookstore

Monday, May 16, 2011

Older People NOT at Greater Risk of Complications with WLS

Neighborhood Conversation on Topic

Recent studies published on WebMD last week indicate that older patients undergoing weight loss surgery are at no greater risk for complications from surgery than younger patients. The broad canvas study of more than 48,000 WLS patients found that, "adults over 65 were not at significantly greater risk of experiencing a major adverse event or dying within a month of their surgeries compared to those in their 30s and 40s, though seniors were more likely to face longer hospital stays." That is good news at a time when more and more older Americans are prolonging life and improving quality of life by weight reduction with Weight Loss Surgery. The full article is below.

Sadly, the study did not report data for post-surgical data beyond the initial 30 days following surgery. It would be interesting to learn the rate of illness recovery for this age set including the reduced signs and symptoms of arthritis, asthma, sleep apnea, bone and joint pain and loss of mobility. I am also curious is the weight loss outcome (pounds lost) is comparable to patients in younger age groups.

In my work with WLS patients of all ages I've observed some age-group specific trends or behaviors that are fascinating. My observations are purely that - observation without scientific foundation by which to draw conclusions. As I share them here please consider them as insight and not necessarily an expectation for how any individual might respond to surgery based on their age group. Here are some things I've seen in patients of WLS who are 50 or older at the time of surgery:

  • Older patients are health driven more than appearance driven in their pursuit of weight loss.

  • Older patients are less inclined to include physical activity as part of their weight reduction effort. This is often due to mobility issues, old injuries, emotional feelings about exercising in public, or pain and discomfort associated with arthritis and age related skeletal disease.

  • Goal objectives for older patients often include improved quality of life; longevity desires "I want to see my grandchildren grow to adults";  desire to reduce debilitating health issues including mobility, risks of heart disease and stroke, diabetes, and early death.

  • Older patients, particularly those who have dieted frequently for weight loss, are prone to the conventional dieting traps: assigning moral values to food (good food vs. bad food); sneaking a treat as a reward or finding loopholes to beat the diet. Even with weight loss surgery in their tool belt older patients are more prone than younger patients to believe in weight loss gimmicks and they frequently add media-hyped supplements or other "quick fix" options to their weight loss surgery program.

  • Older patients tend to be more satisfied with the results of their weight loss surgery and less critical of their body as weight is lost resulting in pronounced wrinkles and excess loose skin. They seem to show fewer signs of body dysmorphic disorder than younger patients who tend to focus on the ideal perfect body rather than improved health and quality of life.

  • Older patients tend to be extremely grateful for surgical help in fighting morbid obesity. After years of frustration they are genuinely happy to be treated for the condition thoughtfully by the medical establishment. Many report that earlier attempts at weight loss were often shunned by their medical care providers and many say they were told by their doctors to lose weight without instructions for how to do it.

  • Every person over 50 that I have spoken with regarding their weight loss surgery has said without hesitation, "I only wish I'd done it sooner."

These are just a few of my observations. I know that many of you out there are over 50 and LIVING with Weight Loss Surgery. I'd love to hear about your experience. Please visit this thread in the LivingAfterWLS Neighborhood to connect with others & share your Golden Years WLS Story!

Below is the full article from WebMD:

Weight Loss Surgery May Benefit Older Adults

Study Shows Weight Loss Surgery Is Safe and Effective for Patients Over 65
By Brenda Goodman
WebMD Health News
Reviewed by Laura J. Martin, MD

May 9, 2011 -- Age does not appear to significantly increase the risks associated with having weight loss surgery, a new study shows.

The study analyzed data on more than 48,000 adults in a national registry who had open or laparoscopic bariatric surgery procedures between 2005 and 2009.  Over that period, the percentage of adults over age 65 who had surgery to lose weight more than doubled.

Researchers found that adults over 65 were not at significantly greater risk of experiencing a major adverse event or dying within a month of their surgeries compared to those in their 30s and 40s, though seniors were more likely to face longer hospital stays.

“If the patient is over age 65, and they’re otherwise relatively healthy, I think this study gives surgeons an opportunity to tell the patients that they can undergo these operations with relatively similar outcomes compared to younger age populations,” says study researcher Robert B. Dorman, MD, PhD, a general surgery resident at the University of Minnesota Medical School in Minneapolis.
The study was presented at Digestive Disease Week 2011 in Chicago.

“There’s been a fairly dramatic increase nationally in offering bariatric surgery to older patients, and I think their study is important in that as we offer surgery to older patients, we need to make sure that outcomes are still safe and that offering surgery to this older population makes sense,” says Thomas H. Magnuson, MD, director of the Johns Hopkins Obesity Surgery Service in Baltimore.

“Older patients definitely benefit from the operation oftentimes more in terms of quality of life. If you can have someone who is 72 years old lose 100 pounds, they can get better quality of life, such as, you know flying on an airplane with their grandkids or just getting around better to enjoy life,” says Magnuson, who was not involved in the research.

Older patients, like younger patients, may also see improvements in medical conditions related to obesity, like type 2 diabetes, he says.

Weight Loss Surgery in Older Adults

For the study, researchers analyzed the records of 48,378 bariatric surgery patients that were collected by hospitals around the U.S. through the American College of Surgeons National Surgical Quality Improvement Program.

Patients included in the study had body mass indexes (BMIs) over 35. Each had undergone one of the following procedures: an open or laparoscopic gastric bypass, an open duodenal switch, laparoscopic gastric banding, or a vertical banded gastroplasty. Seventy-two people died during the study. Eight were over age 65. The risk of dying within 30 days of bariatric surgery was 0.12% for adults aged 35 to 49, 0.21% for those aged 50 to 64, and 0.4% for those over age 65.

After researchers took into account a host of factors thought to affect the outcome of weight loss surgery, including weight, gender, heart disease, diabetes, and kidney function, they found that risk of death for seniors was not statistically significant, meaning that the numbers didn’t show a true difference.

Compared to middle-aged adults, older adults also did not appear to be at any increased risk of having major adverse events, like heart attacks, strokes, and serious infections, after their procedures.
Seniors did have longer hospital stays than younger adults, however, especially if they were over age 70 and the procedure involved opening the abdomen.

Prolonged hospital stays were considered to be anything over three days for a laparoscopic procedure and anything over six days after an open surgery.

Adults aged 65 to 69 had a 20% increased risk of a prolonged hospital stay after a laparoscopic procedure and an 80% increased risk of a prolonged hospital stay after an open procedure compared to those younger than 50.

For those over 70, there was no increased risk after a laparoscopic procedure, but a more than fourfold higher risk of a prolonged hospital stay after an open procedure.
“We tend to focus on younger patients, but obesity affects younger people as well as older people,” Magnuson says.

“Studies like this point out that indeed the risk of surgery isn’t any greater in carefully selected elder patients than younger patients,” he tells WebMD.

For bariatric surgery patients of any age, things that did appear to predict the likelihood of a poor outcome included having type 2 diabetes, being a man, or having a BMI over 55, Dorman says.

No comments: