Introduction: Bariatric surgery is an increasingly common treatment of morbid obesity in the United States, and has demonstrated effective weight loss and improvement of comorbidities. We used the National Surgical Quality Improvement Program (NSQIP) data to characterize bariatric surgery utilization and complication rates in the adolescent population.
Methods: Demographic data, surgical procedures, comorbidities, and 30-day outcomes of 2,862 adolescents ages 18-21 who underwent bariatric surgery were analyzed from NSQIP data-bank for eleven years (2005-2015).
Results: Over 75% of patients were females. Utilization increased with age: 12.0%, 25.0% , 28.2% and 34.9% at 18, 19, 20, and 21 years respectively. Majority of patients identified as either Caucasians or Black/African American (BAA) at 66.9% (73% of US population) and 15.9% (12.6% of US population), respectively. 17.5% identified as Hispanic. Caucasians received bariatric surgery at lower BMIs than BAA with BMIs of 46.6 and 49.7 respectively (p=0.008).
Comorbidities included diabetes in 8.91% (7.69% NIDDM), hypertension (9.5%) and dyspnea on moderate exertion (11.93%).
Longitudinal gastrectomy (LG) was the most common procedure, followed by Roux-En-Y (RY) and Laparoscopic Banding (LB). There has been a sharp trend towards LG in recent years (12% in 2010, to 68% in 2015), while RY utilization declined (55% to 29%).
Surgical complications were 2.9%, with the most common being superficial surgical site infection (0.73%), UTI (0.73%) and pneumonia (0.31%). Re-operation rate within 30-days post-operatively was 1.49%, of which 66.6% were related to the primary surgery. Readmission rate within 30-days post-op was 4.1%. Those with complications had longer length-of-stays (3.60 vs. 1.93 days (p<0.01)), greater reoperation rates (RR=7.77, p<0.001) and readmission rates (RR=9.97, p<0.001).
Conclusion: Morbid obesity is associated with significant comorbidity. LG is increasingly the most utilized form of bariatric surgery. While complications are low, they are associated with greater hospital length-of-stay and readmission and reoperation rates.