Bariatric surgery reduces comorbidities in older patients

Last Updated: 2018-09-12

By Anne Harding

NEW YORK (Reuters Health) - Evidence to support bariatric surgery for improving non-weight loss outcomes in patients over age 65 is of low to moderate strength, the authors of a new systematic review conclude.

"We think the physician and the patient should make decisions based on their own clinical judgment," Dr. Orestis Panagiotou of Brown University in Providence, Rhode Island, told Reuters Health by phone.

Many Medicare-eligible people in the U.S. are candidates for bariatric surgery, Dr. Panagiotou and his team note in JAMA Surgery, online September 5. While bariatric surgery is safe and effective and reduces comorbidities, they add, few studies have looked at safety and efficacy in people 65 and older.

To investigate, they reviewed 16 nonrandomized comparative studies of bariatric procedures including Medicare-eligible patients. Bariatric-surgery patients had a significantly lower 30-day mortality (hazard ratio, 0.50), although one study found higher mortality among bariatric surgery patients compared with controls (1.55% vs. 0.53%, P<0.001).

Cardiovascular disease risk was also significantly reduced with bariatric surgery (HR, 0.59). Surgically treated patients showed improvements in respiratory, musculoskeletal, metabolic and renal outcomes.

Patients had the greatest weight loss with Roux-en-Y gastric bypass (RYGB) at four years' follow-up compared to sleeve gastrectomy (SG) and adjustable gastric banding (AGB), but most non-weight-loss outcomes were similar for the three procedures.

"In the Medicare population, there is low to moderate strength of evidence that bariatric surgery as a weight loss treatment improves non-weight loss outcomes," Dr. Panagiotou and his team conclude. "Well-designed comparative studies are needed to credibly determine the treatment effects for bariatric procedures in this patient population."

Because frail older patients are unlikely to undergo bariatric surgery, concerns about the generalizability of bariatric-surgery trials to the Medicare population may not be warranted, Dr. Margaret E. Smith and Dr. Amir A. Ghaferi of the University of Michigan, Ann Arbor, and colleagues write in a commentary accompanying the study.

"Rather than continuing to demonstrate the already established value of bariatric surgery, we must shift our efforts to advocacy and expanding adoption of this beneficial treatment," they write.

"As medical professionals, we should continue to make recommendations that balance individual risk and potential benefit for our patients, while expanding knowledge about long-term benefits and improving access to lifesaving interventions for all patients," they add. "At some point, we need to ask ourselves how much evidence of the benefits of bariatric surgery is enough."

SOURCE: https://bit.ly/2NEON8V and https://bit.ly/2p1ZioQ

JAMA Surg 2018.