Raul Sebastian1, Melanie Howell2, Ambar Mehta2, Gina Adrales2, Alisa Coker2, Thomas Magnuson2, Michael Schweitzer2, Hien T Nguyen2. 1George Washington, 2Johns Hopkins
Introduction: Bariatric surgery in adolescents has been slow to gain acceptance. This study compares the 30-day postoperative outcomes of bariatric surgery between adolescent (13-21 years) and young adult (>21-45 years) patients using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.
Methods: Demographic data, comorbidities, operative time, readmissions, reoperations, interventions, hospital stay and postoperative complications were compared in both groups. Subsequent analysis addressing reasons for readmissions comparing both groups was performed. Univariate analyses and multivariate logistical regression models were used to evaluate outcomes of adolescent vs young adult patients at MBSAQIP accredited centers.
Results: A total of 85,820 patients were included (2,509 adolescents and 83,311 adults). LSG was the most common bariatric procedure in both groups (67.4% vs 61.2%, p<0.001) followed by LRYGB (24.59% vs 25.63%, p= 0.241) and Laparoscopic adjustable gastric banding (4.22% vs 2.74%, p <0.001). Young adult patients frequently had coexisting comorbidities specifically diabetes, hypertension, GERD, hyperlipidemia, sleep apnea, and chronic steroid use, with an ASA score of 3 or greater (p < 0.001); whereas, the mean BMI in the adolescent cohort was higher (47.38+/-8.34 vs 45.71+/-9.09, p<0.001). Overall 30-day complication rates were similar between groups; with no significant differences in mortality or hospital stay. Significantly shorter operative times were observed in the adolescent group (83.6+/-46 vs 88.1+/-51, p <0.001). In Univariate analysis blood transfusions and VTE rates were significantly lower in the adolescent group but there was no difference after risk-adjusted logistic regression analysis. Analysis of readmission data showed lower rates in adolescents compared to young adults (3.67% vs 4.44% p=0.06). However, adolescents are more frequently readmitted secondary to gallstone disease (6.3% vs 1.9%, p<0.05). The most common reason for readmissions in both groups was nausea and vomiting with fluid/electrolyte depletion, followed by abdominal pain.
Conclusion: Adolescent bariatric surgery is feasible and safe, with outcomes similar to that of young adults. LSG is currently the most common bariatric procedure performed in adolescents which is reasonable given the relative lack of co-morbid conditions within this group. Nausea and vomiting are the most common reason of readmission in both groups, but gallstone disease is significantly higher in adolescents, suggesting that this population should be carefully screened for gallbladder disease preoperatively. Further studies regarding long-term results are needed to elucidate long-term outcomes, such as the durability of comorbidity resolutions in adolescent patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87817
Program Number: P604
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster