Introduction: A recently published review of bariatric surgery in a large Medicare database suggested a prohibitively high mortality rate. We have demonstrated that in carefully selected elderly and Medicare recipients’ gastric bypass can be safely performed with low morbidity and mortality. Evidence for benefit in terms of improvement in co morbidities in these patients however, is lacking. Our hypothesis is that these patients should have improvement in their co morbidities with successful bypass surgery.
Methods: We reviewed our prospectively maintained bariatric database. Over 1000 patients have been accumulated. We identified 46 patients 60 years or older and 31 patients with Medicare as their primary insurer.
Results: In the older patients we had a 1, 3, 5 yr Follow up of 87%, 48%, and 75%. The average length of follow up was 30 months with a range of 1 - 84. The male female ratio for the elderly patients was 13%/87% and was 6%/94% in the Medicare group. The mean pre-op BMI for the elderly group was 50.4 and 56 in the Medicare group. Resolution or improvement of co morbidities is described in the table below. We know of one death 4.5 years from surgery in the Medicare group.
Conclusions: Improvement in the major obesity related co morbidities is seen in elderly and Medicare recipients undergoing gastric bypass surgery. Resolution of GERD is seen in over 90% of both groups. Although hypertension is the least effected in the elderly, 50% still have improvement or resolution of this important co morbidity.

Co morbidities	Elderly Patients Age 60-66 Mean 61.6 (n = 45)		Medicare Recipients Age 31-66 Mean 47.7 (n=31)
	Resolved	Improved	Resolved	Improved
Hypertension	8/34 (24%)	9/34 (26%)	13/21 (62%)	2/21 (10%)	p = 0.02
DM oral meds	15/20 (75%)	2/20 (10%)	9/11 (81%)	1/11 (9%)	ns
DM Insulin	1/3 (33%)	1/3 (33%)	2/6 (33%)	4/6 (67%)	ns
OSA	10/32 (31%)	13/32 (41%)	8/22 (36%)	10/22 (46%)	ns
GERD	23/25 (92%)	0	16/17 (94%)	0	ns