Trends in adolescent bariatric surgery evaluated by UHC database collection

General Surgery, University of Nebraska Medical Center, Omaha, 985126, NE, USA.
Surgical Endoscopy (Impact Factor: 3.26). 05/2012; 26(11):3077-81. DOI: 10.1007/s00464-012-2318-0
Source: PubMed


With increasing childhood obesity, adolescent bariatric surgery has been increasingly performed. We used a national database to analyze current trends in laparoscopic bariatric surgery in the adolescent population and related short-term outcomes.
Discharge data from the University Health System Consortium (UHC) database was accessed using International Classification of Disease codes during a 36 month period. UHC is an alliance of more than 110 academic medical centers and nearly 250 affiliate hospitals. All adolescent patients between 13 and 18 years of age, with the assorted diagnoses of obesity, who underwent laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (SG), and laparoscopic Roux-en-Y gastric bypass (LRYGB) were evaluated. The main outcome measures analyzed were morbidity, mortality, length of hospital stay (LOS), overall cost, intensive care unit (ICU) admission rate, and readmission rate. These outcomes were compared to those of adult bariatric surgery.
Adolescent laparoscopic bariatric surgery was performed on 329 patients. At the same time, 49,519 adult bariatric surgeries were performed. One hundred thirty-six adolescent patients underwent LAGB, 47 had SG, and 146 patients underwent LRYGB. LAGB has shown a decreasing trend (n = 68, 34, and 34), while SG has shown an increasing trend (n = 8, 15, and 24) over the study years. LRYGB remained stable (n = 44, 60, and 42) throughout the study period. The individual and summative morbidity and mortality rates for these procedures were zero. Compared to adult bariatric surgery, 30 day in-hospital morbidity (0 vs. 2.2 %, p < 0.02), the LOS (1.99 ± 1.37 vs. 2.38 ± 3.19, p < 0.03), and 30 day readmission rate (0.30 vs. 2.02 %, p < 0.05) are significantly better for adolescent bariatric surgery, while the ICU admission rate (9.78 vs. 6.30 %, p < 0.02) is higher and overall cost ($9,375 ± 6,452 vs. $9,600 ± 8,016, p = 0.61) is comparable.
Trends in adolescent laparoscopic bariatric surgery reveal the increased use of sleeve gastrectomy and adjustable gastric banding falling out of favor.

5 Reads
  • Source
    • "While laparoscopic adjustable gastric banding (LAGB), rouxen-Y gastric bypass (RYGB), and laparoscopic sleeve gastrectomy (LSG) remain the most common procedures performed in both groups of patients, national trends reveal a decrease in RYGB and LAGB and an increase in LSG since 2008 [40] [45]. These changes may be influenced by factors such as the high reoperation rate of LAGB, relative technical difficulty of RYGB and biliopancreatic diversion, and recent increase in insurance coverage of sleeve gastrectomy with a favorable risk-benefit profile [44] [46] [47] [48]. The efficacy of newer procedures has been increasingly documented as long-term data becomes available, however, the majority of data currently pertain to RYGB as it is still the most common procedure performed worldwide [45]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract: Introduction: As childhood obesity in the US reaches alarming levels, bariatric surgery is becoming a more commonly implemented treatment option due to its high success rate compared with behavioral modification and medical therapy alone. The mechanisms by which it affects body weight and metabolic homeostasis are not well understood. The goal of the present study was to perform a systematic review of pediatric bariatric surgery to evaluate its effectiveness in the context of the physiologic changes that are produced. Materials and Methods: The PubMed database, MEDLINE, Springer Link, Cochrane, and article bibliographies were used to identify original English-language articles published between 2009 and 2014 evaluating pediatric patients. Included studies evaluated patients undergoing Roux en Y gastric bypass, laparoscopic sleeve gastrectomy or laparoscopic adjustable gastric banding and analyzed weight loss, BMI reduction, postoperative complications and co-morbidity resolution post-procedure; all articles had at least a one year follow up. Results: Five studies were included in our evaluation of the three most common bariatric procedures currently performed on the pediatric population for a total of 1,395 patients. The average patient age was 18.2 and 72% of patients were females. Most patients underwent roux en Y gastric bypass (RYGB) (n=659), followed by laparoscopic adjustable gastric banding (LAGB) (n=554) and finally laparoscopic sleeve gastrectomy (LSG) (n=149). The greatest decrease in BMI was seen in the RYGB group who lost an average BMI of 16.7kg/m2, followed by the LSG group with a loss of 14.0kg/m2. The LAGB patients lost 8.2kg/m2. Postoperative complications varied in severity, however the only death occurred in a patient following RYGB. Conclusion:Bariatric surgery has proven to reduce BMI and weight in the adolescent population resulting in an enhanced quality of life and resolution of significant co-morbidities. The mechanism of weight loss is different among the three most common procedures, as is their affect on gut hormone profiles. Ghrelin may have an effect on weight loss, however it is not solely responsible for the procedures’ weight loss effect as levels vary postoperatively. RYGB has been shown to produce the greatest weight loss but postoperative ghrelin levels are not consistently decreased compared to LSG, which demonstrates low ghrelin levels routinely. Additional studies are needed to measure weight loss as it relates to postoperative gut hormone levels, as determining the physiologic changes after these procedures will guide future therapies.
    Full-text · Article · May 2015
  • Source
    • "The exponential rise in obesity has been matched by advances in surgical techniques of bariatric procedures [6, 7]. Traditionally, surgical procedures have been divided into restrictive, malabsorptive, or a combination of both. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of morbidly obese individuals is rising rapidly. Being overweight predisposes patients to multiple serious medical comorbidities including type two diabetes (T2DM), hypertension, dyslipidemia, and obstructive sleep apnea. Lifestyle modifications including diet and exercise produce modest weight reduction and bariatric surgery is the only evidence-based intervention with sustainable results. Biliopancreatic diversion (BPD) produces the most significant weight loss with amelioration of many obesity-related comorbidities compared to other bariatric surgeries; however perioperative morbidity and mortality associated with this surgery are not insignificant; additionally long-term complications including undesirable gastrointestinal side effects and metabolic derangements cannot be ignored. The overall quality of evidence in the literature is low with a lack of randomized control trials, a preponderance of uncontrolled series, and small sample sizes in the studies available. Additionally, when assessing remission of comorbidities, definitions are unclear and variable. In this review we explore the pros and cons of BPD, a less well known and perhaps underutilized bariatric procedure.
    Full-text · Article · Nov 2013 · Gastroenterology Research and Practice
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Data on safety, effectiveness and amelioration of metabolic comorbidities are scarce for adolescents undergoing laparoscopic sleeve gastrectomy (LSG). Methods: Data on a 17 year-old female who underwent LSG due to morbid obesity and quantification of visceral adipose tissue (VAT)/hepatic fat (HF) by MRI scan are presented. In addition, a review of the literature related to LSG in adolescent obesity is provided [search terms: laparoscopic sleeve gastrectomy, adolescence, obesity]. Results: Pre-existing comorbidities in our patient included insulin resistance, NASH (HF: 28%) and hyperuricemia. BMI dropped from 52.9 kg/m(2) to 40.4 and 35.0 kg/m(2) after 6 and 24 months, respectively, following LSG. VAT dropped by 49.2% and by 71.5% within 6 and 24 months, accompanied by a decrease of HF to 1.53% and to 0.85%, respectively. Improvements of metabolic parameters towards normal range, which were reached within 6 months following LSG, could be maintained for 2 years. The review of the literature revealed that 9 original papers on LSG in adolescent obesity are available to date, ranging from single case presentations to case series of 108 patients and including children and adolescents 8-18 years. Conclusions: LSG is a safe and - in the short term - effective bariatric procedure for adolescent obesity (follow up 24 months). Long-term results with larger numbers of patients and involving additional features, such as quantification of VAT and HF as markers of metabolic risk and insulin resistance, are warranted to further understand the effectiveness and safety and to further explore the long-term benefits of this procedure in adolescence.
    No preview · Article · Dec 2012 · Metabolism: clinical and experimental
Show more