Quick study: Weight-loss surgery has increased in adolescents, who have often turned to non-pediatric institutions

THE QUESTION: How common is weight-loss surgery in adolescents and where do they turn to get the procedure?

THE HISTORY: Bariatric surgery, or gastric bypass, can be an effective weight-loss procedure for morbidly obese adults. Until recent years, the surgery was rare among adolescents. Obesity rates for adolescents have increased steadily for the past 30 years. The health consequences of obesity in children can be life-threatening and long-lasting. Although there is growing acceptance of the usefulness of bariatric surgery to improve the health of severely obese teens, the relative rarity of the procedure has made it difficult to track how frequently and where it is performed.

THIS STUDY tracked national trends in adolescent bariatric surgery using the Kids' Inpatient Database, developed by the Health Cost and Utilization Project - a federal-state-industry partnership sponsored by the Agency for Healthcare Research and Quality - to analyze inpatient hospital use by children in the United States. Researchers investigated how many adolescents received weight-loss surgery in 1997, 2000 and 2003, as well as patient characteristics, hospital characteristics and in-hospital complication rates. They used the 2003 Nationwide Inpatient Sample to get each hospital's bariatric surgery volume (adults and children).

The annual frequency of adolescent bariatric surgery in the United States increased five-fold from 1997 (51 patients) to 2003 (282 patients). Patients were predominantly Caucasian females, with a mean age of 16. Most (85 percent) of the procedures were performed in adult hospitals rather than in pediatric institutions, and even more (87 percent) were provided by facilities with limited experience (fewer than five procedures annually) in adolescent bariatric surgery. In-hospital complication rates were similar to those of adult bariatric surgery patients (6 percent).

WHY IT MATTERS: Bariatric surgery on a pa-tient of any age cannot be taken lightly. In addition to the not-insignificant risks of the procedure itself, severely obese adolescents have particular psychological, developmental and metabolic needs that must be addressed before and after the surgery. In 2004 an expert panel recommended the establishment of 'centers of excellence' in adolescent bariatric surgery, where specially trained multidisciplinary teams can provide the care appropriate to these younger patients. This study shows that prior to the recommendations, most of the adolescents had their surgeries at adult hospitals scattered across the country.

Even though the overwhelming majority of adolescent bariatric surgeries occurred at non-pediatric institutions, the researchers found many of the facilities were highly experienced in adult bariatric surgery. It's possible there will never be sufficient demand for adolescent bariatric surgery to support regional centers of excellence. The researchers conclude a workable model might be to have a surgeon experienced in adult bari-atric surgery working closely with a multidisciplinary team of pediatric specialists - the model of care at Lucile Packard Children's Hospital.

The first author of the study is Stanford general surgery resident Peter Schilling, MD. Other Stanford and Packard Children's authors include Matthew Davis, MD; Craig Albanese, MD; Sanjeev Dutta, MD; and John Morton, MD.

It was published in the January issue of the Journal of the American College of Surgeons.


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