Mortality and Causes of Death After Metabolic Bariatric Surgery in Older Patients

BACKGROUND: Metabolic bariatric surgery leads to improved life expectancy in younger individuals, but whether older (> 60 years) individuals benefit from metabolic bariatric surgery is uncertain. This study examined mortality and causes of death in patients with metabolic bariatric surgery at age 60 years or older. MATERIALS AND METHODS: This was a population-based matched cohort study based on all healthcare in Denmark, Finland, and Sweden between 1996 and 2024. All patients who had primary metabolic bariatric surgery at age > 60 years were included and exactly matched 1:5 to comparison individuals of the same age, sex, country, and calendar year with non-operative treatment for obesity. Cox regression provided hazard ratios with 95% confidence intervals for mortality adjusted for multiple obesity-related diseases and frailty. RESULTS: In total, 3879 (16.7%) patients with metabolic bariatric surgery and 19395 (83.3%) patients with non-operative treatment for obesity were included and followed for 176632 person-years. The cumulative mortality was 17.5% (n = 677) among operated patients compared to 23.5% (n = 4536) in the non-operated. In adjusted analyses, metabolic bariatric surgery was associated with 32% decreased mortality (HR 0.68, 95% CI 0.63-0.73). The results were consistent in patients of age > 60-70 years at the time of surgery, but there was no apparent benefit in patients operated at age > 70 years (HR 1.14, 95% CI 0.89-1.47). Operated patients were less likely to die from cardiovascular disease (57.6% versus 65.8%, p < 0.001), but other causes of death were similarly distributed between the groups. CONCLUSION: Metabolic bariatric surgery may decrease mortality in older patients with severe obesity.