Meeting NewsPerspective

Bariatric surgery safe for pediatric patients with obesity

Photo of Robert Swendiman 
Robert Swendiman
Photo of Gerard Hoeltzel 
Gerard Hoeltzel

NEW ORLEANS — Pediatric patients with severe obesity who underwent bariatric surgery between 2015 and 2017 had low rates of readmission, reoperation and complications, regardless of age or BMI, according to study findings presented at the AAP National Conference & Exhibition.

Researchers also noted that more pediatric and adolescent patients who underwent bariatric surgery during the study period opted for sleeve gastrectomy vs. Roux-en-Y gastric bypass.

Although the rate of pediatric obesity has tripled over the course of 3 decades and recent evidence has demonstrated the efficacy of bariatric surgery for reducing comorbidities and mortality and improving quality of life, less than 1% of children with severe obesity undergo the procedure, according to Robert Swendiman, MD, MPP, a general surgery resident in the University of Pennsylvania Health System, and colleagues.

“Choosing weight loss surgery is a life-altering commitment and can take years of planning. It may not be the best option for every patient,” Swendiman told Infectious Diseases in Children. “But if more adolescents undergo surgery, we need to be sure it is a safe option. Our study helps demonstrate that the surgery itself should be considered safe — even in younger patients — with low morbidity.”

The researchers conducted a prospective study that included data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use File. They included patients aged 10 to 19 years who underwent laparoscopic or robotic Roux-en-Y gastric bypass or sleeve gastrectomy (n = 3,705).

The patients had a mean BMI of 47.4 kg/m2. Before surgery, the most common comorbidities included hypertension (33.8%), obstructive sleep apnea (16.1%), gastroesophageal reflux disease (12.9%) and diabetes (11.8%).

Readmission within 30 days of surgery occurred for 2.5% of patients (n = 128), and only 1% (n = 38) needed a second operation. Swendiman and colleagues wrote that the overall complication rate was 1.4% (n = 51).

The researchers noted that no patients with BMIs between 30 and 34.9kg/m2 required reoperation or reported complications. Furthermore, no deaths occurred during the study period.

Most surgeries performed between 2015 and 2017 (80.2%) were sleeve gastrectomies, whereas only 19.8% of patients opted for Roux-en-Y gastric bypass. According to the Swendiman and colleagues, the rate of sleeve gastrectomies increased significantly during the study period, from 73.9% in 2015 to 84.3% in 2017 (P < .001).

The researchers identified a higher rate of readmission when patients underwent Roux-en-Y compared with sleeve gastrectomy (OR = 1.62; 95% CI, 1.06-2.48). Patients who underwent Roux-en-Y also had a higher rate of complications (OR = 2.49; 95% CI, 1.34-4.64).

“Our study found that the odds for experiencing an intra- or post-operative complication were 2.5 times higher for adolescents who underwent Roux-en-Y gastric bypass compared with those who underwent sleeve gastrectomy,” study researcher Gerard Hoeltzel, a first-year medical student at Thomas Jefferson University, told Infectious Diseases in Children. “We believe this finding provides possible rationale for the observed shift in procedure use.”

Age and higher BMI were not linked to increased risk for any adverse outcomes.

“Physicians must carefully balance these risks against the prolonged exposure to severe health risks associated with obesity,” Swendiman said. “So, for the right patients, surgery may serve as a safe and effective way to improve their health, and early referral to centers that work specifically with adolescents may be beneficial.” – by Katherine Bortz

Reference:

Swendiman R, et al. Current trends and outcomes of adolescent bariatric surgery: an MBSAQIP analysis. Presented at: AAP National Conference & Exhibition; Oct. 25-29, 2019; New Orleans.

Disclosures: Hoeltzel and Swendiman report no relevant financial disclosures.

Photo of Robert Swendiman 
Robert Swendiman
Photo of Gerard Hoeltzel 
Gerard Hoeltzel

NEW ORLEANS — Pediatric patients with severe obesity who underwent bariatric surgery between 2015 and 2017 had low rates of readmission, reoperation and complications, regardless of age or BMI, according to study findings presented at the AAP National Conference & Exhibition.

Researchers also noted that more pediatric and adolescent patients who underwent bariatric surgery during the study period opted for sleeve gastrectomy vs. Roux-en-Y gastric bypass.

Although the rate of pediatric obesity has tripled over the course of 3 decades and recent evidence has demonstrated the efficacy of bariatric surgery for reducing comorbidities and mortality and improving quality of life, less than 1% of children with severe obesity undergo the procedure, according to Robert Swendiman, MD, MPP, a general surgery resident in the University of Pennsylvania Health System, and colleagues.

“Choosing weight loss surgery is a life-altering commitment and can take years of planning. It may not be the best option for every patient,” Swendiman told Infectious Diseases in Children. “But if more adolescents undergo surgery, we need to be sure it is a safe option. Our study helps demonstrate that the surgery itself should be considered safe — even in younger patients — with low morbidity.”

The researchers conducted a prospective study that included data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use File. They included patients aged 10 to 19 years who underwent laparoscopic or robotic Roux-en-Y gastric bypass or sleeve gastrectomy (n = 3,705).

The patients had a mean BMI of 47.4 kg/m2. Before surgery, the most common comorbidities included hypertension (33.8%), obstructive sleep apnea (16.1%), gastroesophageal reflux disease (12.9%) and diabetes (11.8%).

Readmission within 30 days of surgery occurred for 2.5% of patients (n = 128), and only 1% (n = 38) needed a second operation. Swendiman and colleagues wrote that the overall complication rate was 1.4% (n = 51).

The researchers noted that no patients with BMIs between 30 and 34.9kg/m2 required reoperation or reported complications. Furthermore, no deaths occurred during the study period.

Most surgeries performed between 2015 and 2017 (80.2%) were sleeve gastrectomies, whereas only 19.8% of patients opted for Roux-en-Y gastric bypass. According to the Swendiman and colleagues, the rate of sleeve gastrectomies increased significantly during the study period, from 73.9% in 2015 to 84.3% in 2017 (P < .001).

The researchers identified a higher rate of readmission when patients underwent Roux-en-Y compared with sleeve gastrectomy (OR = 1.62; 95% CI, 1.06-2.48). Patients who underwent Roux-en-Y also had a higher rate of complications (OR = 2.49; 95% CI, 1.34-4.64).

“Our study found that the odds for experiencing an intra- or post-operative complication were 2.5 times higher for adolescents who underwent Roux-en-Y gastric bypass compared with those who underwent sleeve gastrectomy,” study researcher Gerard Hoeltzel, a first-year medical student at Thomas Jefferson University, told Infectious Diseases in Children. “We believe this finding provides possible rationale for the observed shift in procedure use.”

Age and higher BMI were not linked to increased risk for any adverse outcomes.

“Physicians must carefully balance these risks against the prolonged exposure to severe health risks associated with obesity,” Swendiman said. “So, for the right patients, surgery may serve as a safe and effective way to improve their health, and early referral to centers that work specifically with adolescents may be beneficial.” – by Katherine Bortz

Reference:

Swendiman R, et al. Current trends and outcomes of adolescent bariatric surgery: an MBSAQIP analysis. Presented at: AAP National Conference & Exhibition; Oct. 25-29, 2019; New Orleans.

Disclosures: Hoeltzel and Swendiman report no relevant financial disclosures.

    Perspective
    Stephen R. Cook

    Stephen R. Cook

    Although this surgical database seems of good quality, I’m concerned that there were kids aged younger than 14 years getting surgery. Bariatric surgery for teens might be needed or necessary at times. I think of it like an organ transplant: It must be high quality, safe and rare.

    The low readmission rate and complication rate is not very surprising if you think of it in comparison to what you would see from people who are aged 20 or 30 years. Adults undergoing bariatric surgery are very likely to have a much larger comorbidity or disease burden and for longer periods of time. In other words, a teenager aged 16 years with type 2 diabetes and hypertension does not have as much atherosclerosis in their arteries or strain on their heart as someone aged 36 years. They should be much less likely to have a cardiac event and will probably have much better wound healing.

    The growing attention around bariatric surgery is also leading to more pressure for insurers to cover these procedures. The few bariatric surgeons I’ve asked who have operated on adolescents have said they will perform surgery only if coverage for the procedure is ensured.

    Although we do need to consider surgery treatment for those with severe obesity with comorbidities, there are probably 100 teens who should have lifestyle changes for every one teen who has gotten bariatric surgery. This must also be covered by insurance. The U.S. Preventive Services Task Force has already reviewed the evidence twice for behavioral interventions for children and adolescents with obesity, has found it effective and recommended it for treatment.

    Health systems might be fine with offering bariatric surgery, but they must also make the financial commitment to cover lifestyle interventions that are needed before and after the surgical procedure. These systems must also advocate and negotiate for coverage from insurers for all these services — not just surgery — just like they do for joint replacement, cardiac services or cancer care.

    • Stephen R. Cook, MD, MPH
    • Associate professor of pediatrics
      Golisano Children’s Hospital
      University of Rochester Medical Center

    Disclosures: Cook reports no relevant financial disclosures.

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