Bariatric surgery at the extremes of age

The safety and efficacy of bariatric surgery in adolescents and especially in Medicare population have been challenged. Our aim was to determine short-term (30-day) and long-term outcomes of bariatric surgery in patients >= 60 years and <= 18 years old. Query of our 20-year bariatric surgery database identified 155 patients >= 60 years and 12 patients <= 18 years. We determined morbidity and mortality rates and sent a questionnaire to all surviving patients; 127 of 139 survivors >= 60 years and all 12 adolescents returned the questionnaire (92%) at a mean of 5 years (range 1-19 years). For patients >= 60 years, 30-day mortality was 0.7%, serious morbidity, delaying discharge was 14%, and 5-year mortality was 5%. At a mean of 5 years, body mass index (BMI in kg/m(2)) decreased from a mean (+/- SEM) of 46 +/- 1 to 33 +/- 1 with a 51% resolution of weight-related comorbidities and an 89% subjective overall satisfaction rate. In patients <= 18 years, all with serious comorbidities, there were no deaths and no serious complications. BMI decreased from 55 (range 39-74) to 36 (range 27-53) at 4 years (range 1-8 years). Resolution of weight-related comorbidities was 82%, and satisfaction with outcome was 83%. Thirty-day hospital mortality (< 1%) and 5-year mortality (5%) were much lower than reported previously in the senior population, with acceptable morbidity and importantly, with satisfactory outcomes. Bariatric surgery is safe and effective at high volume centers for patients with morbid obesity at both extremes of age.