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From the JAMA Network
April 2013

Why Isn't Bariatric Surgery for Adolescents Catching On?

Author Affiliations

Author Affiliation: The Johns Hopkins Center for Bariatric Surgery, Baltimore, Maryland.

JAMA Surg. 2013;148(4):314-315. doi:10.1001/jamasurg.2013.18
Abstract

Objectives:  To determine the current rate of inpatient bariatric surgical procedures among adolescents and to analyze national trends of use from 2000 to 2009.

Design:  Retrospective cross-sectional study.

Setting:  Discharge data obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database, 2000 through 2009.

Participants:  Adolescents (defined herein as individuals aged 10-19 years) undergoing inpatient bariatric procedures.

Intervention:  Inpatient bariatric surgery.

Main Outcome Measures:  The primary outcome measure was the national population-based bariatric procedure rate. The secondary outcome measures were trends in procedure rates and type, demographics, complication rate, length of stay, and hospital charges from 2000 through 2009.

Results:  The inpatient bariatric procedure rate increased from 0.8 per 100 000 in 2000 to 2.3 per 100 000 in 2003 (328 vs 987 procedures) but did not change significantly in 2006 (2.2 per 100 000) or 2009 (2.4 per 100 000), with 925 vs 1009 procedures. The use of laparoscopic adjustable gastric banding approached one-third (32.1%) of all procedures by 2009. The cohort was predominantly female and older than 17 years. The prevalence of comorbidities increased from 2003 (49.3%) to 2009 (58.6%) (P = .002), while the complication rate remained low and the in-hospital length of stay decreased by approximately 1 day (P < .001). Increasing numbers of patients had Medicaid as their primary payer source; however, most (68.3% in 2009) had private insurance.

Conclusions:  Despite the worsening childhood obesity epidemic, the rate of inpatient bariatric procedures among adolescents has plateaued since 2003. The predominant procedure type has changed to minimally invasive techniques, including laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Trends show low complication rates and decreasing length of stay, despite increasing comorbid conditions among patients.

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