Study Finds Bariatric Surgery Safe for Morbidly Obese Adolescents

A new study is suggesting bariatric surgery is not only safe but, often times, beneficial for teenagers who are morbidly obese.

Carried out by a team of investigators from Penn Medicine and the Children’s Hospital of Philadelphia, results of the study, which included more than 3700 bariatric surgeries, found the surgery is safe in adolescents and less than 2% should experience complications.

"As the rate of childhood obesity continues to increase, it's critical for us to identify whether weight loss procedures that are frequently performed on adults are also safe and effective options for adolescents and teens," said lead investigator Robert Swendiman, MD, MPP, MSCE, of Penn Medicine.

With rates of childhood obesity exploding over recent decades and an emphasis on treatments to curb the epidemic, investigators sought to determine whether bariatric surgery could be a safe and effective measure for improving health and enhancing quality of life in morbidly obese adolescents. As part of their analyses, investigators examined a cohort of patients aged 19 or younger who underwent minimally invasive Roux-en-Y gastric bypass(RYGB) or sleeve gastrectomy.

Primary outcome measures of the study were the incidence, outcomes, and trends of adolescent bariatric surgery and secondary measure included evaluating whether BMI or age was associated with an increased likelihood of 30-day readmission, reoperation, or complications. All patients included in the study had a BMI of 30 or greater and underwent surgery between 2015 and 2017—patient data used in the analysis were obtained from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program(MBSAQIP) Participant Use File.

A total of 3705 patients were included in the analysis—mean age of the cohort was 18.5 years and the mean BMI was 47.4. Among those included in the study, the most common comorbidities were hypertension(33.8%), obstructive sleep apnea(16.1%), gastroesophageal reflux disease(12.9%), and diabetes(11.8%).

Investigators observed a 30-day readmission rate of 2.5%(128), only 1%(38) of patients required a reoperation, and the overall complication rate was 1.4%. Additionally, no patients in the study with a BMI between 30 and 34.9 experienced a complication or required reoperation.

Analyses revealed RYGB was associated with higher offers for readmission(P=0.027) and complications(P=0.004) when compared to sleeve gastrectomy. Investigators also observed higher BMI and younger age were not associated with an increased risk of any of the outcomes.

Of the patients included in the study, 80.2% underwent sleeve gastrectomy and 19.8% underwent RYGB. The proportion of patients who underwent sleeve gastrectomy increased linearly from 73.9% in 2015 to 84.3% in 2017(P<0.001).

“Our findings suggest that more readily referring patients with lower BMIs for surgery, rather than delaying consideration of surgery until adolescents develop worsening obesity, may prevent patients from suffering the severe health conditions associated with long-term obesity,” Swendiman said.

This study, titled “Current Trends and Outcomes of Adolescent Bariatric Surgery: an MBSAQIP Analysis,” was presented at the American Academy of Pediatrics (AAP) 2019 National Conference & Exhibition in New Orleans.