Background: Bariatric surgery (BS) is an effective treatment to produce long-term weight loss and reduction in obesity-related complications. However, the outcomes and safety of BS in older people has not been well examined and real-world data from the UK is lacking. Furthermore, with increasing life expectancy and rising obesity prevalence, increasing number of older patients are eligible for BS. Hence, we aimed to assess the impact of BS on weight, incident cardiovascular disease (CVD) & mortality in older patients in the UK.
Methods: We conducted a retrospective cohort matched-controlled study of older adults (≥65 yrs) who had BS (Gastric band, sleeve gastrectomy & gastric bypass) between 1/1/199031/1/2018. We used The Health Improvement Network (THIN), a validated & representative primary care electronic database. Each exposed patient (had BS) was matched to 2 controls (no BS) for age, gender and body mass index (BMI). The variables included in the study were identified using Read codes. CVD was defined as a composite of ischemic heart disease (IHD), heart failure (HF) & cerebrovascular accident (CVA).
Results: The analysis included 156 exposed & 299 control participants with mean (S.D.) age 67.3 (2.6) years, 65.05% were female & median (IQR) follow-up duration 2.92 years (1.395.31 years). The percentage total body weight loss (mean±S.D.) was greater in the exposed (19.1%±11.9) vs control group (0.93%±5.4). Incident CVD developed in 7 vs 21 participants (HR 0.62, 95%CI (0.261.48), P=0.28). After adjusting for age, gender, BMI, diabetes, hypertension, smoking, alcohol intake, social deprivation score & ethnicity, the HR for incident CVD in the exposed vs control was 0.53 (95%CI 0.211.33, P=0.178) mainly driven by reduction in incident HF with adj HR of 0.13 (95%CI 0.021.06, P=0.056). The number of deaths were 16 vs 26 participants (IR 30.91 vs 23.9 per 1000-persons-year) the exposed vs control groups respectively. After adjusting for the same variables as above and Charlson comorbidity index, the HR was 1.30 (95%CI 0.652.60, P=0.453).
Conclusions: BS is effective weight loss intervention in older patients. There was trend towards reduction in combined CVD in BS group vs. controls with significant reduction in incident HF. Non-significant increase in mortality was noted which requires further examinations.
12 Sep 2019 - 13 Sep 2019