Roux-en-Y gastric bypass in the elderly: is age a determining factor in our outcomes?

BACKGROUND: While patients are becoming older and the prevalence of obesity increases worldwide, literature on the impact of age on outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) is scarce. The balance between surgical risks and clinical benefits of LRYGB are unclear in relation to age. OBJECTIVES: To evaluate the impact of age on the risk of postoperative complications, postoperative weight loss, and remission of co-morbidities for patients who underwent LRYGB. SETTING: A high-volume center for bariatric surgery. METHODS: A retrospective analysis of 582 patients who underwent LRYGB was performed. Linear logistic regression analyses were performed to evaluate the potential impact of age on the postoperative percentage of total weight loss (%TWL). Multivariable binary logistic regression analyses were performed to evaluate whether age was independently associated with the risk of postoperative complications and likelihood of remission of co-morbidities (hypertension, diabetes, and dyslipidemia). In addition, these outcomes were descriptively analyzed for the following 3 age groups: the young (18-39 yr), the middle aged (40-59 yr), and the elderly (≥60 yr). RESULTS: Patients with hypertension were more prone to developing postoperative complications (odds ratio 2.435, 95% confidence interval: 1.241-4.777) and no other factors were found to be associated with the risk of postoperative complications. Older age was significantly associated with lower %TWL at a postoperative follow-up of 6 (ß = -.117, P = .004), 12 (ß = -.177, P < .001), and 36 months (ß = -.169, P = .001), but not at 60 months (ß = -.097, P = .161). Nonetheless, a %TWL of 30% was observed in patients who were >60 years at the time of surgery. Age was not associated with the likelihood of co-morbidity resolution after LRYGB. The remission of hypertension was less likely in patients with co-existence of diabetes (odds ratio .334, 95% confidence interval: .136-.821) and in patients with a longer length of postoperative follow-up (odds ratio .982, 95% confidence interval: .966-.998). CONCLUSIONS: Although older age seems to be associated with lower postoperative %TWL, elderly patients can still achieve a %TWL of 30% after LRYGB. In this study, age was not found to be an independent predictor of postoperative complications nor the likelihood of co-morbidity resolution. Therefore, older age alone should not be an absolute contraindication for LRYGB.

Cirugía ambulatoria de la hernia inguinal en pacientes ancianos. Estudio comparativo entre mayores y menores de 80 años / Ambulatory inguinal hernia repair in elderly patients. Comparative study of patients over and under 80 years

RESUMEN Introducción: los octogenarios son un grupo demográficamente en crecimiento. Este aumento en la esperanza de vida pone al cirujano frecuentemente frente a pacientes de edad avanzada con una hernia inguinal. Objetivo: analizar la aplicabilidad, seguridad y eficacia del tratamiento quirúrgico ambulatorio de la hernia inguinal en pacientes mayores de 80 años. Material y método: estudio comparativo, de cohorte retrospectiva. Se analizaron todas las hernio plastias inguinales por vía abierta con técnica de Lichtenstein realizadas entre 2008 y 2017, con al menos un mes de seguimiento. Estos pacientes fueron comparados de forma retrospectiva con todos aquellos de iguales características de entre 50 y 79 años tratados durante el mismo período de tiempo. Resultados: entre 2008 y 2017, 491 pacientes ingresaron en el Programa de Cirugía Mayor Ambulato ria y fueron sometidos a reparación de una hernia inguinal con técnica de Lichtenstein. De estos, 133 pacientes (27, 1%) eran mayores de 80 años, y 358 pacientes (72,9%) de entre 50 y 79 años. La mor bilidad posoperatoria global de la serie fue del 9,75% (13,5% para mayores de 80 años y 8,4% para el grupo control, p = NS). Tampoco hubo diferencia estadísticamente significativa en admisión temprana (3,8% vs. 2,8% del grupo control, p = NS). Conclusión: la cirugía ambulatoria en la hernioplastia por vía abierta, en pacientes mayores de 80 años, fue aplicada de forma segura y eficaz.

ABSTRACT Background: Octogenarians are a demographically growing group. This increase in life expectancy of ten makes surgeons face older patients with inguinal hernia. Objective: The aim of this study was to analyze the applicability, safety and efficacy of ambulatory inguinal hernia in patients > 80 years, Material and methods: We conducted a retrospective and observational cohort study. Data from all the open inguinal hernia repair procedures performed using the Lichtenstein technique between January 2008 and December 2017 and followed-up after one month were analyzed. These patients were retrospectively compared with similar patients aged 50-79 years who were treated during the same period. Results: Between 2008 and 2017, 491 patients admitted in the Major Ambulatory Surgery program underwent inguinal hernia repair using the Lichtenstein technique. 133 (27.1%) were > 80 years and 358 (72.9%) were between 50 and 79 years. Overall postoperative morbidity was 9.75% (13.5% in > 80 years and 8.4% in the control group; p = NS). There were no significant differences in unanticipated mortality (3.8% vs. 2.8%un the control group, p = NS). Conclusion: Ambulatory surgery for open inguinal hernia repair in patients > 80 years is a safe and effective strategy.