Weight Loss Surgery After 60
November 2, 2012Weight Loss Surgery After 60
A Surgeon’s Point Of View
At 66 years old, my patient was in reasonably good health. Her heart was strong, and her only medical condition was high blood pressure that was well-controlled with medicine. She was, however, over 100 pounds overweight. “Am I too old for weight- loss surgery?” There was a time, in the not too distant past, when the answer would have been, “Unfortunately, yes.” Fortunately for her, times are changing.
When I began training in weight-loss surgery almost a decade ago, anyone over the age of 60 was automatically excluded from consideration. We routinely rejected people 60 or older stating that they were “too old.” I remember one surgeon during this time operated on a 62-year-old relatively healthy obese man, and it was pretty scandalous. There was no consideration of risk. The potential for an increased life expectancy, improvement in diseases, and better quality of life was not even discussed. One day you qualified. The next day you didn’t. Only specialty centers and “aggressive” surgeons were routinely operating on these older patients.
In medicine, maybe more so in bariatric surgery, things are constantly in flux, and people began looking at the risks associated with operating on older patients. In 2006, The American Surgeon featured an article that looked at 1,339 weight-loss procedures performed on people over the age of 60 at academic centers. As expected, older patients had a slightly higher complication rate and risk of death, but the risk was noted to be less than other comparable surgeries on similar age groups. In other words, they noted a lightly higher risk, but when you compare apples-to-apples, weight loss surgery is a very safe procedure for those over 60.
Another more recent study confirmed this finding as well. Researchers at the University
of Minnesota analyzed the results of 48,378 weight-loss procedures on patients over the age of 65. The data was collected from the American College of Surgeons and published in the Journal of Gastrointestinal Surgery in 2012. What they found was that patients greater than 65 years old did not have a greater risk of major complications. The risk of dying was only slightly greater. Again, in this extremely large study, the risk of surgery in older patients was only a fraction higher when compared to surgery in the younger populations.
There have even been studies with patients having their surgery when they were over 70.
A study that came from the Cleveland Clinic in Weston, Florida examined the effects of weight- loss surgery on 42 patients all over the age of 70 at the time of their procedure. They concluded that “bariatric surgery in carefully screened patients aged >70 years can be performed safely and can achieve modest improvement in co-morbidities.”
What should you do if you are over 60 and desire weight-loss surgery? You should act as though you are 40 and want weight loss surgery. The only way to see if you qualify is to be examined by a bariatric surgeon. They can help you assess your risk, counsel you about surgical and medical options, and give you realistic expectations concerning your procedure. After your evaluation, you can then come to a fact-based conclusion on whether or not weight- loss surgery is right for you.
In my own practice, I would have no problem operating on a healthy older patient. Really, in my mind, the question is not how old you are but how healthy you are. There are some 50-year-olds I would not operate on, but there are some 70-year-olds that I would operate on. It all depends on the risks of that particular patient.
That’s where the science of medicine becomes an art. Sometimes, arbitrary cutoffs don’t work. Sometimes, “never” and “always” can become “perhaps.” Don’t let your age discourage you from pursuing better health. Find out if you qualify, gain as much information as you can, and then make the best decision for yourself.
