Background

Obesity constitutes a major public health issue affecting an increasing number of families. In the United States the percentage of adolescents aged 12-19 years with obesity has reached an alarming level of 21%. Childhood obesity could lead to long term development of heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. The bariatric surgical interventions have emerged as successful alternative to the behavioral and psychological interventions in weight loss for adolescents. The goal of this study is to investigate the trends of Bariatric Surgery in adolescents and to compare the clinical outcomes with adult population.

Methods

Using a state-wide database, SPARCS, all records from adolescents (age 12-21years) and adult population undergoing bariatric surgery during 2005-2014 were examined. The main information extracted were patient’s demographics, surgery type (Roux-en-Y gastric bypass (RYGB), Sleeve Gastrectomy (SG), Laparoscopic Adjustable Gastric Banding (LAGB)), length of stay (LOS), complications and comorbidities. Comparisons in LOS and overall complication between adolescents and adults were based on linear mixed model and generalized linear mixed model, respectively. Log-linear Poisson regression model was used to examine the possible linear trend over years.

Results

During the time period, the observed annual adolescent’s bariatrics cases doubled and increased from 150 in 2005 to 377 in 2014. In Adolescent’s population, increasing trends were noted in the Hispanic population (RR=1.08, p-value<0.0001), use of federal insurance (RR=1.10, p-value=0.0010) and SG procedures (RR= 1.53, p-value <0.0001). It was also noticed that surgeries in group with age from 18 to 21(RR=1.01, p-value<0.0001) increased whereas decreased in the younger age group (RR=0.90, p-value<0.0001). Decreasing trends were noted in the Caucasian population (RR=0.95, p-value<0.0001), use of commercial insurance (RR=0.89, p-value=0.0010), RYGB (RR=0.93, p-value=0.0070) and LAGB (RR= 0.76, p-value<0.0001). When compared with adults population, adolescent population showed significant lower overall comorbidity rate (55.50%vs 81.30%, p-value < 0.0001) , lower complication rate (3.72% vs 5.25%, p-value 0.0009) and shorter length of stay (1.94 vs 2.12 days, p-value= 0.0005). After adjusting for other confounding factors, adolescents patients still had significantly lower complication risk (p-value=0.014) and shorter length of stay (p-value=0.0011)

Conclusions

The Bariatric surgery procedure rates have increased in the adolescent population. Analysis results support that the bariatric surgery is a safe procedure in adolescents with significant lower complication risk and shorter length of stay as compared to the adult population.