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Adolescent bariatric surgery is on the Rise: An analysis of utilization and procedure trends in New York State.

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Adolescent bariatric surgery is on the Rise: An analysis of utilization and procedure trends in New York State.

Shabana Humayon, Maria Altieri, Jie Yang, Lizhou Nie, Konstantinos Spaniolas, Aurora D. Pryor

 Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery. Department of Surgery, Stony Brook Medicine, Stony Brook, New York

Introduction: 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. 

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 406 in 2014.
•In Adolescent’s population, increasing utilization and procedure trends were noted in the Hispanic population (RR=1.08, p-value<0.0001), use of federal insurance (RR=1.10, p-value=0.0003) 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=0.0002) 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), RYGB (RR=0.92, p-value<0.0001) and LAGB (RR= 0.84, p-value=0.0001).
•When compared with the adult population, adolescents showed significantly less comorbidity (55.35% vs 81.08%, p-value<0.0001), complications (3.29% vs 4.95%, p-value=0.0009) and 30-day readmissions (3.76% vs 5.02%, p-value=0.0029).
• Length of stay was also found to be significantly shorter for the adolescent population (1.73 vs 2.00 days, p-value=0.0005).
• After adjusting for other confounding factors, adolescent patients still had significantly lower complication risk (p-value=0.0123) and shorter length of stay (p-value=0.0005)

Conclusion:Bariatric surgery procedure rates have increased in the adolescent population. Our data support that bariatric surgery is safe in adolescents with significantly lower complication risk and shorter length of stay as compared to the adult population. 

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