Clinical Scorecard: Evaluating the Safety of Bariatric Surgery in Patients Aged 65 and Older Amidst the COVID-19 Pandemic
At a Glance
Category
Detail
Condition
Obesity and related comorbidities in older adults
Key Mechanisms
Bariatric surgery as a durable treatment; impact of age and comorbidities on perioperative outcomes; COVID-19 risks in older obese patients
Target Population
Patients aged 65 years and older undergoing bariatric surgery
Care Setting
Global multicentre bariatric surgery centers during the COVID-19 pandemic
Key Highlights
30-day morbidity was significantly higher in patients aged ≥65 years (11.4%) compared to those <65 years (6.6%) undergoing bariatric surgery.
No significant difference in 30-day mortality or symptomatic postoperative COVID-19 infection rates between older and younger groups.
Older patients had a higher prevalence of comorbidities including diabetes, hypertension, obstructive sleep apnea, and hypercholesterolemia.
Guideline-Based Recommendations
Diagnosis
Use age ≥65 years as a cutoff to define older bariatric surgery candidates per WHO and NICE guidelines.
Assess comorbidities thoroughly given their high prevalence in older patients.
Management
Consider laparoscopic sleeve gastrectomy as the most common and preferred procedure in older patients.
Implement advanced perioperative care protocols to mitigate increased morbidity risks in older patients.
Balance risks of surgery against potential COVID-19 complications in older obese patients.
Monitoring & Follow-up
Monitor 30-day postoperative morbidity and mortality closely, especially in patients ≥65 years.
Surveil for symptomatic COVID-19 infection postoperatively despite low incidence in older patients.
Risks
Increased 30-day morbidity associated with older age and higher comorbidity burden.
Potential for perioperative complications heightened in patients ≥65 years.
No significant increase in postoperative COVID-19 infection or mortality observed in older patients.
Patient & Prescribing Data
Adults undergoing primary bariatric surgery, stratified by age ≥65 and <65 years.
Older patients have higher comorbidity rates and morbidity but similar mortality and COVID-19 infection rates post-surgery compared to younger patients.
Clinical Best Practices
Use comprehensive preoperative assessment to identify and optimize comorbidities in older bariatric surgery candidates.
Employ minimally invasive laparoscopic techniques to reduce perioperative risks.
Maintain vigilant postoperative monitoring for complications, especially in patients aged 65 and older.
Consider individual risk-benefit analysis for bariatric surgery during the COVID-19 pandemic in older adults.
