Analysis of Bariatric Surgical Procedures in Adolescents from National Inpatient Sample

Fereshteh Salimi Jazi, MD¹, Tamta Chkhikvadze, MD², Junxin Shi, MD, PhD³. ¹University of Texas Medical Branch, ²NYU Langone Hospital-Brooklyn, Department of Medicine, NYU School of Medicine, Brooklyn, NY, USA, ³Ohio State University, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

Purpose: To identify if advancement of minimally invasive surgery and increasing number of trained minimally invasive surgeons had impact on utilization of bariatric surgical procedures in children and adolescents in the era of obesity epidemics.

Methods: We analyzed 10 years of National Inpatient Sample (NIS) throughout 2005-2014yy. We extracted discharges of patients <20y, with associated ICD-9 diagnosis and procedure codes of morbid obesity (278.01, V85.4), open gastric bypass (OGB- 44.31, 44.39, 43.89), laparoscopic gastric bypass (LGB- 44.38), sleeve gastrectomy (SG-43.82), laparoscopic gastric banding (LAGB- 44.95) and laparoscopic gastroplasty (LG-44.68). Technical and systemic surgical complications were identified using according ICD-9 codes. All extracted numbers were weighted to national estimates. Trends and available socio-demographics were reviewed. Mean length of stay (LOS) and mean charges (MC) adjusted by inflation index were analyzed.

Results: Throughout the analyzed years total number of major bariatric procedures remained relatively unchanged (Table 1), with substitution of most procedures with SG since 2011 (Figure 1). LAGB and LG procedures have been essentially abandoned. OGB constituted only minor portion (2.3%) of total bariatric procedures by 2014. 98% of all bariatric procedures were performed in adolescents 13-19yy, and 2% in children <12y. By 2014 two of the most commonly performed bariatric procedures in adolescents were SG (64%) and LGB (29%). Sustained significant female (76%) vs. male (24%) predominance, with majority of patients being white (56%), and privately insured (65%), as well as increasing access to treatment for least wealthy patients (21%->30%) and those with public insurance (13.5%->30%) was noted. While procedures were equally distributed between teaching and non-teaching urban hospitals before 2011, majority of cases have shifted to teaching institutions since (80% vs. 20%). Only non-reportable number of inpatient deaths and overall ~2-4% of complication rate was identified, most common being hemorrhage and respiratory complications. No cardiac complications have been reported since 2011, but increased incidents of acute kidney failure were observed. MC have increased($46,300->$54,049) and LOS has marginally decreased over the years(2.67->2.39).

Conclusion: Despite above described favorable shifts in between procedure types and socioeconomics, our study did not demonstrate increase in utilization of weight loss surgery in adolescents. Bariatric procedures are underutilized but continuously performed in this population, following adult curves. SG has demonstrated to be safe, effective and has been extensively performed since 2011, constituting 64% of all adolescent bariatric procedures in 2014. Multidisciplinary efforts should be made to increase identification and referral of eligible candidates for surgery.