Sleeve gastrectomy versus Roux-en-Y gastric bypass in patients Aged >= 65 years: a comparison of short-term outcomes

Background: Bariatric surgery in the elderly population has been reported as feasible and safe. Sleeve gastrectomy (SG) seems to have fewer complications than Roux-en-Y gastric bypass (RYGB) even in the 65 years of age population. We analyzed the difference in weight loss between SG and RYGB in patients age 65 years. Objectives: To analyze and compare outcomes between SG and RYGB in patients 65 years of age and older. Setting: Academic hospital, United States. Methods: After internal review board approval, we retrospectively reviewed 2486 patients who underwent either SG or RYGB between 2005 and 2018 at our institution. Basic demographics, preoperative body mass index (BMI), and co-morbidities were described. We identified all patients age >= 65 years and subsequently divided them into 2 groups based on type of bariatric procedure per-formed. Analysis and comparison of outcomes between these groups were completed. Postoperative BMI was reviewed at 6, 12, and 24 months and percent excess BMI loss (%EBMIL, as defined by the ASMBS clinical committee) was calculated accordingly. The t test and chi(2) analysis were performed for nominal and categorical variables, respectively. Results: From 2486 patients reviewed, 22.7% (n = 565) were aged >= 65 years. From these, 43.1% (n = 244) underwent SG and 56.8% (n = 321) underwent RYGB. White and female patients were predominant in both groups. Mean age was similar for both populations (SG: 71.1 +/- 4.0, RYGB: 71.7 +/- 4.5; P = .12). Pre-procedure mean BMI for both groups was close in value, but the difference was statistically significant (40.5 +/- 5.5 for SG versus 43.7 +/- 7.2 for RYGB; P < .0001). Postoperative follow-up rates were similar in both groups at 12 and 24 months (SG: 51.2% and 31.6%; RYGB: 48.3% and 34.3%; P = .49 and P = .5). The %EBMIL at 6, 12, and 24 months was higher for the RYGB group than the SG group (59.3 +/- 27.9, 72.1 +/- 29.5, 77.4 +/- 26.1 versus 50.2 +/- 21.9, 55.2 +/- 25.6, 43.9 +/- 32.2; P < .01, P < .01, and P < .01, respectively). Complication rates were signif-icantly higher in RYGB versus SG (27.7% versus 9.4%; P < .01). We observed significantly higher anastomotic ulcer and stricture rates for RYGB versus SG (7.2% and 5.9 versus 0% and 0%; P < .01 and P < .01, respectively). RYGB had a higher rate for gastrointestinal obstruction requiring inter-vention (2.2% versus .4%; P =.07). A similar de novo gastroesophageal reflux disease rate was noted in both procedures (3.7% versus 3.7%; P = .98). No leaks were reported in either group. Conclusions: Both SG and RYGB are effective weight loss procedures for patients aged >65 years. RYGB seems to have higher %EBMIL at 1 and 2 years; however, when compared with SG, complication rates appear to be almost 3 times higher. (C) 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.