Eficácia da cirurgia bariátrica em idosos

Abstract

Introduction: We have observed a progressive increase in life expectancy in the world population. Projections indicate that we will have more than 34 million Brazilians over the age of 60 in 2025. This same line of growth is also seen in obesity rates, with worrying levels in this age group. In this scenario, bariatric surgery has become an increasingly frequent therapeutic option for these people, since it is considered one of the bests treatments for the control of morbid obesity. Methods: We retrospectively selected 62 patients over 60 years of age who underwent gastrointestinal shunt surgery with Roux-en-Y reconstruction from 2009 to 2017. As a control, 178 patients under the age of 60 were selected. The effects of bariatric surgery on the resolution of metabolic diseases (diabetes, hypertension and dyslipidemia), weight loss and its correlation with the remission of metabolic diseases were evaluated, as well as the use of medications to treat these diseases before and after surgery. Results: The average age in the elderly group was 62,8, while in the youngest the average was 38,9. Diabetes and hypertension were more prevalent in the elderly (P<0,001), while dyslipidemia was not different in the preoperative period (P=0,358). The mean total body weight loss was -36.8 kg at 12 months and -37.9 kg at 24 months in the elderly group, with no difference for the non-elderly group (P = 0.257). The elderly had remission rates of diabetes, hypertension and dyslipidemia of 51,5%, 45,5% and 48,8% at 24 months, respectively. There was no correlation between weight loss and remission of metabolic diseases in the elderly group. In non-elderly people, remission rates reached levels of 77,8%, 67,3% and 65,5% for diabetes, hypertension and dyslipidemia, respectively, at 24 months. In this group, there was a correlation between weight loss and remission of metabolic diseases (rb=0,42; P=0,004). Both groups showed a significant reduction in the number of medications used to control metabolic diseases, both at 12 and 24 months. Conclusion: Our study indicates that although the effects of bariatric surgery are not as effective for the control of metabolic diseases in the elderly as in non-elderly people, it presents important clinical results, and should be part of the treatment of severe obesity in this segment of the population.