In the Journals

Gastric bypass improves survival in adults older than 35 years

Improved survival was found among patients undergoing Roux-en-Y gastric bypass surgery when they were older than 35 years.

According to the researchers, the surgery also is protective against mortality in older patients and can reduce age-related increases in mortality in patients with severe obesity not undergoing surgery.

Lance E. Davidson, PhD, of the department of exercise sciences at Brigham Young University in Provo, Utah, and colleagues evaluated data on patients undergoing Roux-en-Y gastric bypass surgery (RYGB; n = 7,925) at a private surgical practice from 1984 to 2002 to determine whether the surgery is effective in reducing mortality in patients undergoing surgery at different ages. Participants were divided into four age groups: younger than 35 years, 35 to 44 years, 45 to 54 years and 55 to 74 years. Researchers also evaluated group-matched patients with severe obesity who did not undergo surgery. Follow-up was conducted for a mean of 7.2 years.

A significantly lower adjusted all-cause mortality risk was found for participants undergoing bariatric surgery who were aged 35 to 44 years (HR = 0.54; 95% CI, 0.38-0.77), 45 to 54 years (HR = 0.43; 95% CI, 0.3-0.62) and 55 to 74 years (HR = 0.5; 95% CI, 0.31-0.79), but not for those younger than 35 years (HR = 1.22; 95% CI, 0.82-1.81), compared with those who did not undergo surgery. External causes of death were more common among participants younger than 35 years who underwent surgery compared with those who did not undergo surgery (HR = 2.53; 95% CI, 1.27-5.07). The risk for all-cause mortality was increased among women younger than 35 years who underwent surgery (HR = 1.42; 95% CI, 0.9-2.26).

“This study found that the increased mortality from external causes in patients undergoing gastric bypass surgery was limited to the subgroup of women who underwent surgery before 35 years of age,” the researchers wrote. “Importantly, this study implies that gastric bypass surgery is protective against mortality, even for patients who undergo surgery at an older age. Gastric bypass surgery also reduces the age-related increase in mortality risk compared with severely obese individuals who do not undergo surgery.”
Malcolm K. Robinson, MD, assistant professor at Harvard Medical School, wrote that, “One should be judicious in the workup, selection and postoperative support of both young and old patients before offering this powerful tool for treating obesity.” by Amber Cox

Disclosure: Davidson and Robinson report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

Improved survival was found among patients undergoing Roux-en-Y gastric bypass surgery when they were older than 35 years.

According to the researchers, the surgery also is protective against mortality in older patients and can reduce age-related increases in mortality in patients with severe obesity not undergoing surgery.

Lance E. Davidson, PhD, of the department of exercise sciences at Brigham Young University in Provo, Utah, and colleagues evaluated data on patients undergoing Roux-en-Y gastric bypass surgery (RYGB; n = 7,925) at a private surgical practice from 1984 to 2002 to determine whether the surgery is effective in reducing mortality in patients undergoing surgery at different ages. Participants were divided into four age groups: younger than 35 years, 35 to 44 years, 45 to 54 years and 55 to 74 years. Researchers also evaluated group-matched patients with severe obesity who did not undergo surgery. Follow-up was conducted for a mean of 7.2 years.

A significantly lower adjusted all-cause mortality risk was found for participants undergoing bariatric surgery who were aged 35 to 44 years (HR = 0.54; 95% CI, 0.38-0.77), 45 to 54 years (HR = 0.43; 95% CI, 0.3-0.62) and 55 to 74 years (HR = 0.5; 95% CI, 0.31-0.79), but not for those younger than 35 years (HR = 1.22; 95% CI, 0.82-1.81), compared with those who did not undergo surgery. External causes of death were more common among participants younger than 35 years who underwent surgery compared with those who did not undergo surgery (HR = 2.53; 95% CI, 1.27-5.07). The risk for all-cause mortality was increased among women younger than 35 years who underwent surgery (HR = 1.42; 95% CI, 0.9-2.26).

“This study found that the increased mortality from external causes in patients undergoing gastric bypass surgery was limited to the subgroup of women who underwent surgery before 35 years of age,” the researchers wrote. “Importantly, this study implies that gastric bypass surgery is protective against mortality, even for patients who undergo surgery at an older age. Gastric bypass surgery also reduces the age-related increase in mortality risk compared with severely obese individuals who do not undergo surgery.”
Malcolm K. Robinson, MD, assistant professor at Harvard Medical School, wrote that, “One should be judicious in the workup, selection and postoperative support of both young and old patients before offering this powerful tool for treating obesity.” by Amber Cox

Disclosure: Davidson and Robinson report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.