Published on: 10 Sept 2025

Background:

With rising life expectancy, a growing number of older adults are living with obesity, posing significant healthcare challenges. Metabolic and bariatric surgery (MBS) is the most effective long-term treatment for obesity and related comorbidities, but its safety and efficacy in patients aged 70 and older (septuagenarians) remain debated due to concerns about increased surgical risks in this population.

Objective:

This study aimed to systematically review and meta-analyze existing evidence to assess the safety (30-day morbidity and mortality, hospital stay) and efficacy (weight loss and comorbidity improvement) of MBS in septuagenarians compared to younger patients.

Methods:

A comprehensive literature search was conducted across multiple databases up to December 31, 2024, identifying studies involving patients aged ≥70 years undergoing primary MBS. Outcomes included 30-day morbidity and mortality, length of hospital stay, weight loss metrics (BMI, % total weight loss [%TWL], % excess weight loss [%EWL]), and improvements in type 2 diabetes mellitus (T2DM) and hypertension (HTN). Study quality was assessed using the ROBINS-I tool. Data from 12 retrospective observational studies including 2528 septuagenarians and 194,666 younger patients were pooled using a random-effects model.

Results:

• Demographics: Septuagenarians had a mean age of 73.9 years and a lower preoperative BMI (42.4 kg/m²) compared to younger patients (46.0 kg/m², p<0.0001).
• 30-day Morbidity and Mortality:
  The pooled 30-day morbidity rate in septuagenarians was 9.0%, with mortality at 0.7%. Compared to younger patients, septuagenarians had a 55% higher odds of 30-day complications (OR 1.55) and over fourfold increased odds of mortality (OR 4.31). However, sensitivity analysis excluding one large influential study reduced the mortality risk increase and rendered it statistically non-significant (OR 2.17, p=0.178). Hospital length of stay was not significantly different overall, though a subgroup analysis combining RYGB and SG showed a modestly longer stay in older patients.
• Procedure-Specific Morbidity:
  Sleeve gastrectomy (SG) was associated with lower 30-day morbidity (6.6%) than Roux-en-Y gastric bypass (RYGB) (10.8%) in septuagenarians, suggesting SG may be safer for this age group.
• Late Complications:
  Late complications, such as strictures or hernias, did not differ significantly between septuagenarians and younger patients, indicating similar long-term safety profiles.
• Weight Loss Outcomes:
  Postoperative BMI was similar between groups; however, septuagenarians exhibited significantly lower %TWL and %EWL compared to younger patients (mean differences of approximately -2.7%). This may reflect age-related physiological differences such as reduced metabolic rate, sarcopenia, and altered hormonal responses.
• Comorbidity Improvement:
  Rates of remission or improvement in T2DM and HTN were comparable between septuagenarians and younger patients, demonstrating meaningful metabolic benefits in the older group despite potentially longer disease duration.

Discussion:

This meta-analysis provides comprehensive evidence that MBS is feasible and effective in selected septuagenarians, with important caveats. While older adults have higher short-term risks of morbidity and mortality, these risks are still relatively low in absolute terms and may be mitigated by careful patient selection and perioperative management. The lower complication rate with SG compared to RYGB suggests that surgical approach should be individualized in this population.

Limitations:

All included studies were retrospective observational designs with moderate risk of bias, limiting the strength of conclusions. High heterogeneity in long-term complications and weight loss outcomes likely reflects variability in surgical techniques, patient characteristics, and outcome definitions. Functional and quality-of-life outcomes were not reported. Prospective studies with standardized frailty assessment and longer follow-up are needed.

Conclusions:

Metabolic and bariatric surgery can be safely offered to well-selected septuagenarians, providing meaningful weight loss and metabolic benefits despite higher perioperative risks compared to younger patients. Age alone should not exclude patients from surgery; individualized assessment including frailty is essential. Future high-quality prospective research is needed to optimize patient selection and care pathways for this expanding demographic.

SOURCE/READ FULL ARTICLE: https://journals.lww.com/international-journal-of-surgery/abstract/9900/safety_and_efficacy_of_bariatric_or_metabolic.3235.aspx

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