Metabolic and bariatric surgery in adults aged 69 years and older in England: a matched survival retrospective cohort study.

Abstract

The prevalence of obesity is rising alongside population ageing, yet the long-term benefits of metabolic and bariatric surgery (MBS) in older adults is unclear. We aimed to evaluate the impact of MBS on survival in individuals aged 69 years and older with obesity. We conducted a retrospective cohort study of patients aged 69 years and older managed in a UK tertiary bariatric centre between Jan 1, 2015, and Dec 31, 2024. Patients were eligible for inclusion if they had complete clinical data. Patients who underwent MBS were compared with matched controls who did not undergo MBS. Mahalanobis distance matching was performed (1:1) using age, BMI, American Society of Anesthesiologists grade, type 2 diabetes, and cardiovascular disease. Data were retrieved from electronic health records. The primary outcome was all-cause mortality after matching. Cox regression was used to assess survival. Of the 186 patients, 44 (24%) underwent MBS. The median age was 71 years (IQR 70-74), 114 (61%) of 186 patients were women, 72 (39%) were men, median BMI was 41 kg/m² (IQR 37-45), and median follow-up was 39 months (IQR 22-70). After matching, 44 MBS patients were compared with 34 control participants. Matched Kaplan-Meier analysis showed superior survival among MBS patients compared with control patients (log-rank p=0·010). MBS was associated with a 68% reduction in all-cause mortality on univariate analysis (hazard ratio 0·32 [95% CI 0·11-0·92]; p=0·036) and a 75% reduction in all-cause mortality on multivariate analysis (0·25 [0·08-0·77]; p=0·015). In MBS patients, the postoperative 30-day morbidity rate was 9%: Dindo-Clavien grade III-IV complications occurred in three (7%) of 44 patients, and one person (2%) died. In a specialist setting, MBS was independently associated with improved survival in individuals aged 69 years and older, with acceptable perioperative risk. Chronological age alone should not preclude consideration for MBS. These findings support further evaluation of surgical options in well selected older adults with obesity. National Institute for Health and Care Research.