For the approximately 30 million morbidly obese people in the United States considering weight reduction surgery, age should be a prime consideration, according to a new study led by Oregon Health & Science University bariatric surgeon Robert O' Rourke, M.D. The research is published in the March issue of the Archives of Surgery, one of the JAMA/Archives journals.
In a retrospective study of patients who underwent weight reduction surgery, also known as bariatric surgery, in the OHSU Digestive Health Center from April 14, 2000, to December 23, 2003, O' Rourke and colleagues found that increased age is a predictor for complications.
"With the demand for obesity surgery markedly increasing, the ability to predict patients" outcomes has become increasingly important," said O' Rourke, also an assistant professor of surgery (general surgery) in the OHSU School of Medicine. "Bariatric procedures are technically challenging operations performed on high-risk patients. In addition to the traditional risk factors - BMI, other illnesses - surgeons should counsel patients about the higher risks associated with increased age and about the higher risks of some procedures."
The researchers examined several risk factors, including age, BMI (body mass index), gender, surgeon experience, other illnesses, type of procedure and whether the procedure was open or performed laparoscopically, that is performed through several tiny quarter-sized incisions with fiberoptic instruments. They found that bariatric surgery patients aged 60 and older had longer hospital stays, regardless of the type of bariatric procedure, and more major and minor complications.
Other risk factors did not appear to be associated with increased risk for complications, the researchers report.
In addition, the researchers discovered the bariatric procedure known as the biliopancreatic diversion with duodenal switch, or duodenal switch, is associated with a higher complication rate than gastric bypass, the most commonly performed of the bariatric operations, accounting for approximately 80 percent of all bariatric procedures performed in the United States.
Based on their findings, the researchers recommend surgeons caution patients aged 60 or older of the higher risk of postoperative complications and of the higher risks associated with the duodenal switch.
To conduct the research, O' Rourke and colleagues reviewed data from 452 patients (372 women and 80 men, average age 44 years) over a four-year period, with an average follow-up period of more than a year, who had received either gastric bypass surgery, or duodenal switch at the OHSU Digestive Health Center.
Gastric bypass surgery involves sectioning off a small portion of the stomach into a pouch that connects directly to the small intestine.
BILIOPANCREATIC DIVERSION WITH DUODENAL SWITCH
Biliopancreatic diversion with duodenal switch involves removing part of the stomach, leaving a slightly larger pouch than in gastric bypass, then also performing an intestinal bypass-like procedure by attaching the duodenum (the first part of the small intestine) to the lower part of the small intestine.
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