Bariatric surgery is a safe option for young adolescents with morbid obesity

October 25, 2019

NEW ORLEANS - Bariatric surgery is safe for teens with morbid obesity and is beneficial for young patients who would otherwise face potential lifelong risks of death associated with obesity, according to new research being presented at the American Academy of Pediatrics (AAP) 2019 National Conference & Exhibition.

The research abstract, "Current Trends and Outcomes of Adolescent Bariatric Surgery: an MBSAQIP Analysis," will be presented on Oct. 27 at Ernest N. Morial Convention Center.

"Our study helps shed light on the safety of bariatric surgery, especially for young adolescents," said presenting author Robert A. Swendiman, MD, MPP, MSCE, at the Hospital of the University of Pennsylvania. "As clinicians we must balance the risks of surgery versus prolonged exposure to the ill effects of obesity in children."

The analysis for MBSAQIP, or Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, reviewed more than 3,700 cases involving patients ages 10-19 who underwent either a minimally invasive (laparoscopic or robotic) Roux-en-Y gastric bypass or sleeve gastrectomy.

Researchers analyzed 3,705 cases of adolescents, ages 10 to 19, finding few complications (1.4%); readmissions to the hospital (3.5%); reoperations (1.0%); and no deaths in the first 30 days after surgery.

They noted that about 80% of the cases were sleeve gastrectomies, which over the past few years have become the preferred choice over the gastric bypass. The authors noted that the chances of readmission were 62% higher in gastric bypass patients when compared with the gastric sleeve patients, and patients undergoing the gastric bypass were more than twice as likely to suffer complications.

The most commonly reported comorbidities included hypertension (33.8%), obstructive sleep apnea (16.1%), gastroesophageal reflux disease (12.9%), and diabetes (11.8%).

"Our findings demonstrate that the perioperative risks are really quite low for sleeve gastrectomy," Dr. Swendiman said. "So, for the right patients, surgery may provide an important option for improving their health."

Gerard Hoeltzel will present an abstract of the study, available below, from 8 a.m.-9:15 a.m. Oct. 27 at the convention center, Room 348-349.

In addition, Mr. Hoeltzel will be among highlighted abstract authors to give brief presentations and be available for interviews during a press conference on Sunday, Oct. 27 starting at noon in rooms 208-209 (Press Office) of the Ernest N. Morial Convention Center. During the meeting, you may reach AAP media relations staff in the National Conference Press Room at 504-670-5406.

Please note: Only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org.

Abstract Title: Current Trends and Outcomes of Adolescent Bariatric Surgery: an MBSAQIP Analysis

Robert Swendiman, MD, MPP, MSCE

BACKGROUND: Over the past three decades, the rate of childhood obesity has tripled in the United States. Despite evidence demonstrating that bariatric surgery can ameliorate comorbidities, reduce early mortality, and enhance quality of life, fewer than 1% of children with severe obesity undergo surgical weight loss interventions each year. PURPOSE: We sought to assess the incidence, outcomes, and trends of adolescent bariatric surgery using a validated national database. We also sought to determine if body mass index (BMI) or age was associated with an increased likelihood to experience 30-day readmission, reoperation, or complications. METHODS: We performed a prospective study using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use File. We queried all patients age ? 19 years with a BMI ? 30 kg/m2 from 2015 - 2017 who underwent minimally invasive (laparoscopic or robotic) Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Descriptive and univariate analyses were performed to determine differences in demographic and clinical data between groups. A multivariable logistic regression model was employed to evaluate the influence of patient and procedural characteristics on readmissions, reoperations, and overall complications. RESULTS: The study population included 3,705 encounters of adolescents ages 10 to 19 years old with a mean BMI of 47.4 (7.9) kg/m2. The most commonly reported comorbidities included hypertension (33.8%), obstructive sleep apnea (16.1%), gastroesophageal reflux disease (12.9%), and diabetes (11.8%). The 30-day readmission rate was 2.5% (n = 128). Reoperations occurred in only 1.0% (n = 38) of patients, and the overall complication rate was 1.4% (n = 51). No patients with BMI between 30 and 34.9 kg/m2 experienced a complication or required reoperation. There were also no reported deaths. RYGB was associated with higher odds for readmission (OR = 1.62, CI: [1.06 - 2.48], p = 0.027) and complications (OR = 2.49, CI: [1.34 - 4.64], p = 0.004) compared to SG. Higher BMI and younger age were not associated with an increased likelihood to experience any of the studied outcomes. A total of 80.2% of patients underwent SG compared to 19.8% for RYGB, and the proportion of patients undergoing SG increased linearly from 73.9% in 2015 to 84.3% in 2017 (p < 0.001). CONCLUSIONS: Bariatric surgery is safe for adolescents and has a low rate of complications (1.4%). SG is quickly becoming the operation of choice for bariatric surgical treatment of adolescents with obesity, which may explain the low rates of poor outcomes observed in this study. Earlier surgical intervention, with respect to both age and BMI class, was not associated with increased risk for complications. Early consideration of surgical therapy may be warranted in adolescents with obesity to reduce the risk of longstanding comorbidities and mortality given this safety profile.

American Academy of Pediatrics

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