Comparative effectiveness of sleeve gastrectomy versus Roux-en-Y gastric bypass for weight loss and safety outcomes in older adults

Background: Most bariatric studies in older adult patients have focused on older operations with limited follow-up and equivocal results. Objectives: To compare weight loss and safety in patients ages >= 65 years undergoing laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Setting: Nine different bariatric surgery centers with 23 surgeons serving over 30,000 bariatric patients. Methods: Participants were >= 65 years who had a SG or LRYGB between January 1, 2010, and March 15, 2015. Outcomes measured were change in weight up to 4 years after surgery; 30-, 90-, and 365-day mortality; and early (<= 30 d) and late (31-365 d) complication rates. To control for nonrandom assignment, SG and LRYGB cases were propensity matched at the time of surgery for gender, race/ethnicity, procedure year, body mass index, presence of diabetes and/or hypertension, and overall co-morbidity burden. Results: There were 177 LRYGB and 252 SG patients (n = 429). Patients were female (70%), 67 years old (range 65 to 79), non-Hispanic white (64%), and had a body mass index of 42.6 +/- 5.4 kg/m(2). The year 4 follow-up rate was 75% (n = 322). LRYGB patients lost significantly more weight than SG after a median 4 years of follow-up (P < .001), mortality was similar, and LRYGB had higher overall complication rates (30.5%) than SG (15.4%). Conclusions: Elderly patients lost significantly more weight with LRYGB compared with SG. Further studies will be necessary to determine if the long-term effects of greater weight loss warrant the increased risk involved with LRYGB. (C) 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.