Gastric Sleeve Surgery After Age 60

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Gastric Sleeve Surgery After Age 60

Age alone does not rule out a gastric sleeve under current guidelines. The 2022 ASMBS/IFSO guidelines state that "there is no evidence to support an age limit" for people seeking metabolic and bariatric surgery, and they recommend careful selection that includes a check for frailty. Complication rates are slightly higher in older adults, and studies of Medicare patients suggest fewer problems after a sleeve than after a gastric bypass.

What the guidelines say about age

The 2022 guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) make four points about older adults:

There is no evidence to support an age limit.
In people in their seventies, surgery is associated with "slightly higher rates of postoperative complications compared with a younger population," while still producing substantial weight loss and remission of related conditions.
"Frailty, rather than age alone, is independently associated with higher rates of postoperative complications."
Other health conditions and the type of operation are "more predictive of 30-day adverse outcomes than age alone."

Frailty means reduced strength, endurance and reserve: slow walking, weak grip, exhaustion, unplanned weight loss or difficulty with daily tasks. A guideline sets no rule for your case, so ask whether Dr. Davtyan has an upper age limit or decides case by case.

The 2019 clinical practice guideline from ASMBS and four other societies (Mechanick and colleagues) adds two practical points. It notes that the sleeve "has been identified as a preferable option in those over age 65 years," and it states that patients aged 65 and older should be referred to an accredited comprehensive center. Surgery with Dr. Davtyan is done at a hospital where he has surgical privileges. Ask the office which hospital would be used and what its accreditation level is.

What studies of older patients show

Two well-known randomized trials say little about this age group. SLEEVEPASS enrolled adults aged 18 to 60 and SM-BOSS enrolled adults aged 18 to 65. Medicare data and observational studies fill much of the gap for people over 65.

Sleeve compared with bypass in Medicare patients

Chao and colleagues (Annals of Surgery, 2022) analysed Medicare claims from 2012 to 2017. Among 8,510 patients entitled to Medicare by age, meaning 65 or older, the sleeve was associated with fewer problems over three years than the gastric bypass:

Outcome, age 65 or older	Sleeve	Gastric bypass
Complications within 3 years	20.1%	24.7%
Reinterventions within 3 years	14.0%	21.9%
Rehospitalization within 3 years	41.8%	45.8%
Death within 30 days	0.3%	0.5%
Death within 3 years	1.8%	2.8%

The differences in complications, reinterventions and rehospitalization were statistically significant. The differences in deaths were not. The figures also show that readmissions are common in this age group after either operation, which is worth planning for.

Surgery compared with no surgery

A systematic review of 16 studies in Medicare-eligible patients (Panagiotou and colleagues, JAMA Surgery, 2018) found that bariatric surgery led to greater weight loss than no surgery or conventional treatment, and was associated with lower cardiovascular risk and lower overall mortality beyond the first 30 days. In the study with the longest follow-up, 5.9 years, the hazard ratio for death was 0.50. Within the first 30 days, one study found higher mortality after surgery than in people treated without it (1.55% against 0.53%).

The same review found that bypass appeared to produce more weight loss than the sleeve, that overall complications were not significantly different, and that major complications were more common after bypass. The authors rated the strength of evidence as low to moderate and warned that these comparisons are open to confounding and selection bias.

Extra checks before surgery

The work-up is described in tests before gastric sleeve surgery. For older adults, some parts carry more weight. Ask the office which clearances Dr. Davtyan would want for you.

Heart and lungs. The 2019 guideline bases cardiac testing on individual risk factors and requires a formal cardiology consultation for patients with known heart disease.
Frailty and function. How far you can walk, whether you live alone, and who can help in the first weeks.
Medications. Blood thinners, diabetes medicines and blood pressure tablets all need a plan for the days around surgery and the months after, because needs can change with weight loss.
Bones and muscle. Weight loss at any age can include some muscle and bone. The 2019 guideline lists a minimum of 60 grams of protein a day, calcium and vitamin D supplements, and a bone density scan (DXA) at two years. It finds insufficient data to warrant a routine scan before surgery outside formal osteoporosis recommendations, so ask whether you need one. See vitamins and lab tests after a sleeve.

Recovery steps are on our gastric sleeve recovery timeline. A sleeve cannot be reversed, which matters at any age.

Medicare and other coverage after 65

Medicare's National Coverage Determination for bariatric surgery covers certain procedures for beneficiaries with a BMI of 35 or more, at least one obesity-related condition and previous unsuccessful medical treatment for obesity. It leaves coverage of a stand-alone laparoscopic sleeve to the regional Medicare contractor when those conditions are met. Medicare Advantage plans can add their own networks and authorizations. Our page on Medicare and Lap-Band care has background. Ask us whether we can see patients on your plan before you commit to anything.

Frequently asked questions

Am I too old for a gastric sleeve at 70?

Not on age alone under the guidelines. The 2022 ASMBS/IFSO guidelines found no evidence to support an age limit, and they report that people in their seventies still achieve substantial weight loss, with slightly higher complication rates than younger patients. The decision turns on your health conditions, your level of frailty and what you hope to gain.

Is a sleeve or a bypass the better choice after 65?

There is no single answer. In Medicare data, the sleeve was associated with fewer complications and reinterventions over three years, while a systematic review found more weight loss after bypass. Reflux, diabetes, previous abdominal surgery and your own priorities all count. Our page on gastric bypass versus gastric sleeve sets out the trade-offs.

Will weight loss surgery help my knees or a planned joint replacement?

It may. The 2022 ASMBS/IFSO guidelines say there are reports suggesting surgery may be effective as a bridge to total joint replacement in people with a BMI of 35 or more when it is done more than two years before the joint surgery. If an orthopedic surgeon has asked you to lose weight first, bring that letter to your consultation.

Does losing weight after 60 weaken bones?

The 2019 guideline says decreases in bone density over time are common after bariatric surgery, particularly in postmenopausal women. It lists calcium of 1,200 to 1,500 mg a day, vitamin D of at least 2,000 to 3,000 international units a day adjusted to your blood level, adequate protein and a bone density scan at two years. Ask what exercise is suitable for you.

Talk with Dr. Davtyan in Rancho Cucamonga

Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon with Davtyan Medical Weight Loss & Wellness at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730. Call 909-355-2525 or toll free 877-9-BE-SLIM (877-923-7546), or use our contact page. The first consultation is complimentary, and Hablamos Español. More topics are in our Rancho Cucamonga gastric sleeve guide.

Gastric Sleeve Surgery After Age 60

Gastric Sleeve Surgery After Age 60

What the guidelines say about age

What studies of older patients show

Sleeve compared with bypass in Medicare patients

Surgery compared with no surgery

Extra checks before surgery

Medicare and other coverage after 65

Frequently asked questions

Am I too old for a gastric sleeve at 70?

Is a sleeve or a bypass the better choice after 65?

Will weight loss surgery help my knees or a planned joint replacement?

Does losing weight after 60 weaken bones?

Talk with Dr. Davtyan in Rancho Cucamonga

Sources

More in the Gastric Sleeve in Rancho Cucamonga guide

Understanding the sleeve

Weighing your options

Getting care in Rancho Cucamonga

Adult BMI Calculator

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Glendale

Rancho Cucamonga

South Coast Lap-Band

Marina Del Rey Hospital

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