Ann M Rogers, MD1, Patrick Vincent2, Eugene Won, MD3, Tung Tran, MD4, Gail Ortenzi, RN1. 1Penn State Hershey Medical Center, 2Penn State College of Medicine, 3University of California, Irvine, Dept of Surgery, 4Washington Hospital Center, Dept. of Surgery
The frontal cortex is among the last areas of the brain to fully develop. It houses higher functions such as impulse control, planning and working memory, the bases for mature judgment. Risk-taking behavior, need for novelty, and need for peer affirmation are well described in adolescents. Neuroimaging studies demonstrate that the adolescent brain continues to mature into the mid-20s. Bariatric surgery is offered to adolescents of adult size and adult bone age, who are shown to be able to make informed decisions. The impetus to study our patient population under age 25 derived from the above-cited neuroscience literature on brain maturity, to help design a program taking into account the differences found in younger patients in order to best serve their needs.
After obtaining approval from the Institutional Review Board of the Pennsylvania State University College of Medicine, we performed a retrospective chart review of all patients undergoing laparoscopic Roux-en-Y gastric bypass at the Hershey Medical Center between the years of 2007-2011. 766 patients were included in the analysis. Every patient under 25 years of age was matched with a patient > 25 year old who most closely approximated the same preoperative gender, body mass index, and comorbidities. We evaluated percent excess weight loss (%EWL) and percent body mass index loss (%BMIL) between the groups at one, two and three years after surgery. We also collected data on attendance at scheduled follow-up visits.
The mean age of the total cohort of patients in our study was 44 and the mean preoperative BMI was 46.9. There were relatively few patients in the under-25 age group (n=19). In this group, the mean age was 21.85 (range 18.2-24.9) and the mean BMI was 47.81 (range 41-63), with 18 females (94.7%) and one male (5.3%). In our matched cohort of patients 25 or older, the mean age was 48.32 (range 34.7-65.34) and BMI 47.83 (range 41-63.8). There was a statistically significant difference in age between the groups, but not between preoperative BMIs. While follow-up was poor for both groups at all points in time, there was a statistically significant difference in follow-up at the one-year point after surgery, with about 37% of the younger patients coming for their one-year visit compared to about 74% of the older patients. Follow-up at the two- and three-year points was lower for the younger patients, but there was not a statistical difference. Of those who followed up, there was no statistically significant difference in %EWL or %BMIL between the two groups at any point.
Based on this preliminary, limited data, there is unlikely to be a significant difference in weight loss from gastric bypass between older and younger patients. However, younger patients’ compliance with follow-up, for a variety of reasons, will be less good. New modalities, such as email and texting services, may facilitate appropriate evaluations.