Trends in Adolescent Bariatric Surgery Evaluated By Uhc Database Collection

Pradeep Pallati, MD, Anton Simorov, MD, Avishai Meyer, MD, Vishal Kothari, MD, Corrigan Mcbride, MD, Dmitry Oleynikov, MD. University of Nebraska Medical Center

 Background: Adolescent bariatric surgery has been increasing the last few years, as a result of increasing childhood obesity. Many institutions have reported their individual experiences with adolescent bariatric surgery, but, so far, there are no nationwide reports of outcomes of adolescent bariatric surgery. Our goal is to present the trends of laparoscopic bariatric surgery and the short term outcomes by analyzing the nationwide database.
Methods: Discharge data from the University HealthSystem Consortium (UHC) database was accessed using International Classification of Disease (ICD-9) codes during a 45-month period from October 2007 to June 2011. UHC is an alliance of more than 100 academic medical centers and nearly 200 affiliate hospitals. UHC`s Clinical Data Base / Resource Manager (CDB/RM) allows member hospitals to compare patient-level risk-adjusted outcomes for performance improvement purposes. All adolescent patients between 13 and 18 years of age, with the assorted diagnosis of obesity, undergoing laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (GB) were evaluated. Data was obtained on a yearly basis, except the last year, which included only 9 months. The main outcome measures analyzed were morbidity, mortality, overall length of hospital stay (LOS), overall cost, intensive care unit (ICU) admission rate and 30-day readmission rate. These outcomes were compared to those of adult bariatric surgery.
Results: Adolescent laparoscopic bariatric surgery was performed on 416 patients during this time period. At the same time, 59,490 adult bariatric surgeries were performed. Of the adolescent procedures, 182 patients underwent LAGB, 46 had SG while 188 patients underwent GB. LAGB has shown a decreasing trend (51, 68, 35 & 28), while SG has shown an increasing trend (3, 8, 15 & 20) over the years. GB remained stable (52, 44, 60 & 32) throughout the study period. Among UHC-identified comorbidities in adolescents, hypertension (25.7%), chronic pulmonary disease (21.8%), depression (16.1%), diabetes (15.4%), liver disease (11.3%), and hypothyroidism (6%) were the most common co-morbidities. The individual and summative morbidity and mortality rates for these procedures were zero. Comparing to adult bariatric surgery, the length of stay (1.95+/-1.30 vs. 2.36 +/- 3.13, p= 0.008) and overall cost (8,795+/-5162 vs. 10179 +/-8685, p<0.0001) are significantly better while ICU admission rate (8.68% vs. 6.91%, p=0.19) and 30-day readmission rate (1.23% vs. 1.98%, p= 0.34) are comparable in adolescent bariatric surgery.
Conclusions: Trends in adolescent laparoscopic bariatric surgery reveal the increasing use of sleeve gastrectomy with falling favor of adjustable gastric banding. Morbidity and mortality in these procedures is low. Further studies are needed to evaluate the long term data regarding long-term weight loss, late complications and mortality.

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