Age Limits vs. Term Limits, part 2

So when is "old" too old?

As in so many other areas in medicine, this has a relative answer.

Relative risk of age needs to be viewed in terms of potential benefit, as is also the case with younger morbidly obese patients that undergo surgery.  As most now (as opposed to a number of years ago) are in agreement that Bariatric surgery is not solely a "cosmetic procedure" to reduce body mass and "improve" a patient's appearance, the potential for significant health benefit is always in the equation.

Obstructive Sleep Apnea, Diabetes, Hyperlipidemia, HTN, symptomatic / activity- limiting weight bearing OA, and other comorbidities have been shown to substantially improve with surgery and its attendant weight loss.  Advancing age has not been shown to consistently diminish the potential benefits from surgery.

Also keep in mind a patient's genetic risks / predispositions, as well as the potential for increased risk of malignancies with age and decreasing quality of life, on the continuum of time,  as a further characterization of what life may be like if the condition of excess (and likely increasing weight) over continued time is allowed to persist. As the saying goes, there aren't too many significantly overweight people in nursing homes, in their 80s and beyond, these days.

There certainly is a generally agreed upon increased risk as the aging process continues, with the added effects of time and comorbid conditions,  under admittedly variable control (lipids, glyco, BP, etc.), which I think we are quicker to add up than the potential benefits of surgery in a patient of increased age.

Patients are cleared all the time for other types of surgery in their 70s and beyond.  The workup for such a patient is understandably more detailed to qualify end organ status, to assess perioperative risk, as well as to establish whether or not the patient is as optimized as they can be prior to elective surgery.

Our guidelines state that anyone over age 50 sees cardiology preop for potential further evaluation, in order to obtain clearance before surgery.  All patients, regardless of age,  have an EKG in the office as part of their preop workup and data base establishment. Anyone with DM2 of 5-10 years duration, and on insulin, and/or under poor diabetic control should see caridology as well,  given their risk for silent cardiac events.  Most patients are also cleared by their PCP prior to surgery as well just before the time of their procedure.

How do the insurance companies deal with this issue?  Most are in agreement that anyone over the age of 65-70 requires a peer to peer discussion (Insurance Company Medical Director to Surgeon) .  In our experience, the patient usually gets through that review,  as long as our workup is intact, they have been cleared by Cardiology have had adequate diagnostic testing, and stand to experience significant health benefits from surgery and weight loss (from comorbidty reduction / resolution).

to further put it in perspective, and I think I have mentioned it before, but it is worth restating here. (hint: NEJM 2007)

The risks of surgery / anesthesia do slowly increase with advancing age.  However, when you can show the substantial health benefits in the comorbidites listed above, with improved quality of life, and significant disease-associated mortality reduction, (actually greater than Coronary Artery Bypass Grafting) and you have an interested patient of increased age questioning whether Bariatric Surgery is right for them, it pays substantial dividends to be in-the-know!