Evaluating Safety and Durability of Adolescent Metabolic and Bariatric Surgery

Introduction

Metabolic bariatric surgery (MBS) has demonstrated safety in its usage in the adolescent population and can aid in curbing the rising obesity epidemic. However, long-term data surrounding durability of MBS in this population is limited. This study aims to examine both short and long-term outcomes of MBS in adolescents, as well as identify patient characteristics and demographics that may impact operative safety and durability.

Methods

The New York Statewide Planning and Research Cooperative System was utilized to identify patients 12-19 y old who underwent a bariatric procedure from 2007 to 2018. Patients were followed for the need for revisional or conversion (RC) procedures. Safety was defined by 30-d readmission, length of stay (LOS), and in-hospital complications. Durability was characterized by the incidence of RC after the initial procedure. Variables that were significantly associated with each outcome on univariable analysis were selected for in multivariable regression models.

Results

2241 adolescents underwent MBS in the study time frame; 58.46% of them underwent sleeve gastrectomy (SG). The median LOS was 1.66 ± 1.04 d. The overall in-hospital complication rate was 3.44%; 30-d readmission rate was 3.17%. Roux-en-Y Gastric Bypass (RYGB) patients were more likely to have a 30-d readmission than SG (OR = 1.75 95% CI 1.03-2.96). Factors associated with in hospital complications were preexisting hypertension (OR = 2.008 95% CI 1.141-3.535) and hypothyroidism (OR = 2.459 95% CI 1.132-5.341). Overall, the RC rate was 6.65%. RC rate following laparoscopic adjustable gastric banding (LAGB), RYGB, and SG was 27.33%, 2.08%, and 1.22%, respectively. The incidence of RC was significantly different between patients undergoing different types of bariatric surgery (P-value<0.0001), and it was significantly higher after LAGB comparing to RYGB (HR = 16.16, 95% CI: 7.56-34.51) as well as comparing to SG (HR = 9.22, 95% CI: 5.07-16.78). Insurance status, race or ethnicity, and socioeconomic disadvantage were not significantly associated with 30-d readmissions, in-hospital complications, LOS, or RC.

Conclusions

Adolescent patients experience a low rate of postoperative adverse events following MBS. These procedures remain durable over time for this patient cohort. These positive results are regardless of race, ethnicity, and insurance status. This study identifies that female patients and LAGB patients are at highest risk for need for eventual RC, suggesting the need for closer postoperative follow-up for these specific patient cohorts.