In geriatric patients, bariatric surgery has been shown to result in sustained reductions in medication use and significant improvements in quality of life. “There is rich literature regarding the benefits of bariatric surgery, but there continues to be some hesitation to perform these procedures in older patients,” explains Russyan Mark Mabeza, MPH. “In general, increasing age has been associated with greater operative risk, but this higher risk is not as well-defined in bariatric surgery.”

Clinical & Financial Outcomes in Older & Younger Adults

For a study published in Surgery & Obesity-Related Disorders, Mabeza and colleagues examined the incidence of, and factors related to, in-hospital mortality, postoperative complications, readmissions, and resource utilization in elderly patients undergoing bariatric surgery. “We assessed the clinical and financial outcomes of bariatric surgery for older adults compared with their younger counterparts,” Mabeza says. “Our overall goal was to provide concrete numbers regarding the risks, which could aid in surgical decision making and help with counseling of patients who would benefit from bariatric procedures.”

The study sample included adults aged 45 and older from the 2016-2019 Nationwide Readmissions Database who underwent elective laparoscopic gastric bypass or sleeve gastrectomy. Patients aged 65 and older—the geriatric cohort—were compared with non-geriatric adults, defined as those aged 45-64. Of an estimated 351,292 patients who met inclusion criteria, 12.6% (44,183) were included in the geriatric cohort.

Bariatric Surgery Safe in the Elderly, But Risks Increase With Age

Results from the study showed that 0.3% of geriatric patients died during their index hospitalization, compared with a rate of 0.04% among non-geriatric patients (Table). When compared with younger age, geriatric status was associated with a 2.5-fold higher mortality risk and significantly higher odds of in-hospital mortality. “A big takeaway from our study was that bariatric surgery is quite safe, with low overall rates of complications even in geriatric patients,” says Mabeza. “However, there was a significantly higher rate of death with increasing age, a trend that was more pronounced in gastric bypass surgery compared with sleeve gastrectomy.”

Patients aged 65 and older also had higher odds of respiratory, infectious, and renal complications, as well as prolonged hospitalizations. Elderly patients undergoing bariatric surgery experienced a 0.19-day incremental increase in the length of stay and $620 in attributable hospitalization costs, but this was not associated with a significant difference in 30-day readmissions. “Our data showed that patients aged 65 and above faced greater odds of complications,” Mabeza says. “Even so, postoperative complications remained low in this national cohort of bariatric patients.”

A Foundation for Enhanced, Shared Decision Making

Data on hospitalization costs and resource utilization for geriatric patients undergoing bariatric operations are lacking, but the study findings may help clinicians with shared decision-making discussions. “Our findings can be discussed with geriatric patients when considering bariatric surgery as an option to treat their obesity,” Mabeza says. “For patients who decide to undergo a bariatric procedure, the data can give an idea about certain risks to consider and the likelihood of these risks manifesting. From a policy and healthcare coverage standpoint, the data can support efforts to increase access to bariatric surgery for both younger and older adults.”

More research is needed to assess factors that may influence postoperative mortality and complications in bariatric surgery in older patients, according to Mabeza. “Additional studies are needed on the long-term impact of bariatric surgery on geriatric patients,” he adds. “While our study gave us insights on short-term complications and resource use, it would be useful to see how bariatric procedures impact weight loss, complication rates, and other health metrics across a longer period.”