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Steinberger AE, Nickel KB, Keller M, Wallendorf M, Sprague J, Nicol GE, Dimou FM, Eagon JC, Eckhouse SR, Shakhsheer BA. National Trends in Pediatric Metabolic and Bariatric Surgery: 2010-2017. Pediatrics 2022; 150:189942. [PMID: 36373280 DOI: 10.1542/peds.2022-057316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The childhood obesity epidemic has grown exponentially and is known to disproportionately affect minority groups. Successful treatment of this complex health issue requires a multidisciplinary approach including metabolic and bariatric surgery (MBS) for qualifying pediatric patients. This study examines current national trends in pediatric bariatric surgery from 2010 to 2017 using the National Inpatient Sample. METHODS This study analyzed MBS among pediatric patients <19 years old using weighted discharge data from 2010 to 2017. The primary outcome was national procedure rates. Secondary analyses included procedure type, demographics, BMI, comorbidities, length of stay, and complication rates. RESULTS From 2010 to 2017, annual bariatric procedure rates increased from 2.29 to 4.62 per 100 000 (P < .001). Laparoscopic sleeve gastrectomy outpaced Roux-en-Y gastric bypass and laparoscopic adjustable gastric band over time (0.31-3.99 per 100 000, P < .0001). The mean age was stable over time 18.10-17.96 (P = .78). The cohort was primarily female (76.5% to 75.4%), white (54.0% to 45.0%), and privately-insured (59.9% to 53.4%). Preoperative BMI increased from 2010 to 2017 (P < .001), whereas number of obesity-related comorbidities was stable (P > .05). Length of stay was <2 days (2.02-1.75, P = .04) and in-hospital complication rates were low (7.2% to 6.45%, P = .88). CONCLUSIONS Pediatric MBS is underutilized nationally with disproportionately lower rates among minority groups. Despite incremental progress, further investigation into the racial and social determinants that limit access to pediatric weight loss surgery is critical.
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Affiliation(s)
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
| | - Matthew Keller
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
| | | | | | - Ginger E Nicol
- Child and Adolescent Psychiatry, Department of Psychiatry
| | | | | | | | - Baddr A Shakhsheer
- Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO
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Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for adolescents with severe obesity, but no long-term studies are available with more than10 years of follow-up data to document sustained improved outcomes. METHODS A total of 96 patients who completed MBS at 21 years of age or younger in a tertiary academic center 2002 to 2010 were contacted for a telehealth visit. Body weight, comorbidity status, social/physical function status, and long-term complications were evaluated 10 to 18 years after surgery. RESULTS Mean participant (83% female, 75% Hispanic) age at MBS was 18.8 (±1.6) years (median age 19 years, range 15-21 years), and median pre-MBS BMI was 44.7 kg/m 2 (SD 6.5). At follow-up (mean 14.2 [±2.2] years) post-MBS (90.6% Roux-en-Y gastric bypass [RYGB] or 8.3% laparoscopic adjustable gastric banding [LAGB]) mean total body weight decreased by 31.3% (interquartile range [IQR] 20.0% to 38.9%); 32.0% (IQR, 21.3% to 40.1%) among RYGB participants and 22.5% (IQR, 0.64% to 28.3%) among LAGB participants. Patients with pre-MBS hyperlipidemia (14.6%), asthma (10.4%), and diabetes/hyperglycemia (5.2%) reported 100% remission at follow-up (p < 0.05 for all). Pre-post decrease in hypertension (13.5% vs 1%, p = 0.001), sleep apnea (16.7% vs 1.0%, p < 0.001), gastroesophageal reflux disease (13.5% vs 3.1%, p = 0.016), anxiety (7.3% vs 2.1%, p = 0.169), and depression (27.1% vs 4.2%, p < 0.001) were also found. CONCLUSIONS Significant sustained reductions in weight and comorbidities, and low rates of long-term complications, a decade or more after completing MBS as an adolescent were found. These findings have important implications for adolescents who may be considering MBS for weight reduction and overall health improvements that extend into adulthood.
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Affiliation(s)
- Nestor de la Cruz-Muñoz
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Luyu Xie
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children’s Health System of Texas, Dallas, TX
| | - Hallie J Quiroz
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Onur C Kutlu
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Folefac Atem
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children’s Health System of Texas, Dallas, TX
| | - Steven E Lipshultz
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
- Oishei Children’s Hospital, Buffalo, NY
| | - M Sunil Mathew
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children’s Health System of Texas, Dallas, TX
| | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children’s Health System of Texas, Dallas, TX
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Samaan JS, Abboud Y, Yuan L, Toubat O, Mirocha J, Qian E, Lee N, Subramanyam C, Samakar K. Racial disparities in bariatric surgery postoperative weight loss and patient satisfaction. Am J Surg 2021:S0002-9610(21)00534-1. [PMID: 34583849 DOI: 10.1016/j.amjsurg.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/11/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND A growing body of evidence has demonstrated racial disparities in bariatric surgery (BS) outcomes. We aimed to investigate the impact of race on postoperative percent excess weight loss (%EWL) and patient satisfaction. METHODS Single center retrospective study of patients who underwent BS January 2012 to November 2017. Statistical analysis utilized Chi-squared, ANOVA and multivariable regression. RESULTS A total of 378 patients were included. African American patients lost significantly less weight compared to Caucasian and Hispanic patients (39.0 %EWL, 53.4 %EWL and 52.3 %EWL, respectively). A significant difference remained after adjustment for possible confounders. No difference in postoperative satisfaction was found. CONCLUSIONS Our study adds to the existing literature demonstrating racial disparities in BS postoperative EWL, despite adjusting for possible confounders, while contributing to the limited literature examining Hispanic patients. Furthermore, we examined an understudied outcome in postoperative patient satisfaction and found no racial disparity despite disparity in EWL.
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Zhao J, Samaan JS, Abboud Y, Samakar K. Racial disparities in bariatric surgery postoperative weight loss and co-morbidity resolution: a systematic review. Surg Obes Relat Dis 2021:S1550-7289(21)00288-4. [PMID: 34257030 DOI: 10.1016/j.soard.2021.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/15/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022]
Abstract
While bariatric surgery is an accepted treatment for morbid obesity, the impact of race on surgical outcomes remains unclear. This systematic review aims to compare differences in weight loss and co-morbidity outcomes among various races after bariatric surgery. PubMed, Medline, and SCOPUS databases were queried to identify publications that included more than 1 racial group and reported weight loss outcomes after bariatric surgery. A total of 52 studies were included. Non-Hispanic black (NHB) patients comprised between 5.5% and 69.7% and Hispanic patients comprised between 4.7% and 65.3% of the studies' populations. Definitions of weight loss success differed widely across studies, with percent excess weight loss being the most commonly reported outcome, followed by percent total weight loss and change in body mass index (BMI). Statistical analyses also varied, with most studies adjusting for age, sex, preoperative weight, or BMI. Some studies also adjusted for preoperative co-morbidities, including diabetes mellitus, hypertension, and hyperlipidemia, or socioeconomic status, including income, education, and neighborhood poverty. The majority of studies found less favorable weight loss in NHB compared to Hispanic and non-Hispanic white (NHW), patients while generally no difference was found between Hispanic and NHW patients. The trend also indicates no association between race and resolution of obesity-related co-morbidities. Racial minorities lose less weight than NHW patients after bariatric surgery, although the factors associated with this discrepancy are unclear. The heterogeneity in reporting weight loss success and statistical analyses amongst the literature makes an estimation of effect size difficult. Generally, racial disparity was not seen when examining co-morbidity resolution after surgery. More prospective, robust, long-term studies are needed to understand the impacts of race on bariatric surgery outcomes and ensure successful outcomes for all patients, regardless of race.
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Steinberger AE, Youngwirth LM, Kim SE, Duke NN, Skinner A, Gordee A, Kuchibhatla M, Armstrong S, Seymour KA. Adolescent Bariatric Surgery: Racial Disparities in 30-Day Outcomes Using the MBSAQIP from 2015 to 2018. Obes Surg 2021; 31:3776-3785. [PMID: 34043179 DOI: 10.1007/s11695-021-05500-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Racial disparities exist in obesity prevalence and obesity-related comorbid conditions among youth. We hypothesized that non-White adolescents would have poorer 30-day outcomes after adolescent bariatric surgery. METHODS Adolescent patients 19 years or younger who had bariatric surgery from January 2015 to December 2018 were identified in the Metabolic and Bariatric Surgery Accreditation and Quality Initiative Program datafiles. Patient characteristics and 30-day perioperative outcomes were compared across racial groups. Trends in utilization of adolescent bariatric surgery were evaluated by race and procedure. RESULTS Bariatric surgery was performed in 3177 adolescents with a mean age of 17.9 years [standard deviation (SD) 1.1 years]. The majority of patients were White 71.5% (2,271), while only 16.4% (520) were Black, and 12.1% (386) were other. Black adolescents 42.7% (222) more commonly presented with a BMI >50kg/m2 compared to 28.4% (645) White and 27.2% (105) other. Baseline hypertension and sleep apnea were more common among Black adolescents than other racial groups (P< 0.05). Black adolescents with LRYGB comprised 4.6% (48) of procedures in 2015 and only 1.5% (11) in 2018. Clavien-Dindo complications and all-cause readmission rates were similar among racial groups. Mean BMI decrease after 30 days was greatest for Black patients after Roux-en-Y gastric bypass, with a loss of 3.1 BMI points (SD 1.5). CONCLUSIONS Despite similar short-term outcomes, significant disparities exist for Black adolescents who qualify for bariatric surgery. Further investigation is warranted to better understand the racial differences that limit access and utilization of this safe and effective intervention.
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Affiliation(s)
- Allie E Steinberger
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Se Eun Kim
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Naomi N Duke
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Asheley Skinner
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Alexander Gordee
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Sarah Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Keri A Seymour
- Department of Surgery, Duke University, 407 Crutchfield St, Durham, NC, 27704, USA.
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Abstract
The worldwide obesity crisis is not isolated to adults; rather, obesity in adolescents has reached epidemic levels as well. Bariatric surgery continues to be one of the most effective treatments for obesity, both in adults and adolescents, with new evidence continually emerging; however, research surrounding outcomes of these procedures in younger patients is limited in comparison with data available for adults. Further, it is important to examine psychological aspects of obesity in adolescents, as well as effects of surgery on mental health endpoints. Conditions such as anxiety, depression, anger, and disruptive behavior show increased prevalence among obese adolescents, but minimal research exists to examine changes in such conditions following bariatric surgery. Additionally, there is growing evidence of a bidirectional relationship between sleep (quality; disorders) and the development of obesity, and the effects of this relationship are particularly pronounced in the vulnerable adolescent population. This review aims to compile and discuss the results of literature within the last 5 years with regard to overall efficacy of bariatric surgery specifically in adolescent patients in terms of weight and body mass index (BMI) reduction, hormonal changes, and co-morbidity resolution, as well as data surrounding sleep and psychological outcomes. Race, ethnicity, and socioeconomic status were also examined. From this review, we conclude that current research supports bariatric surgery in adolescents as an effective method of treatment for obesity and related co-morbidities; however, minimal long-term data exists to adequately assess efficacy and trends into adulthood. These areas are ripe for future study.
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Affiliation(s)
- Cherie A Roberts
- Department of Nutrition, Columbia University, New York, NY, United States.,Department of Biomedical Sciences, Touro College of Osteopathic Medicine-Harlem, New York, NY, United States.,Department of Osteopathic Medicine, Touro College of Osteopathic Medicine-Harlem, New York, NY, United States
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D'agostino E, Patel H, Hansen E, Mathew M, Nardi M, Messiah S. Effect of participation in a park-based afterschool program on cardiovascular disease risk among severely obese youth. Public Health 2018; 159:137-43. [DOI: 10.1016/j.puhe.2018.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/18/2018] [Accepted: 02/20/2018] [Indexed: 12/15/2022]
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Jaramillo JD, Snyder E, Farrales S, Stevens M, Wall JK, Chao S, Morton J, Pratt JS, Hammer L, Shepard WE, Bruzoni M. A multidisciplinary approach to laparoscopic sleeve gastrectomy among multiethnic adolescents in the United States. J Pediatr Surg 2017; 52:1606-9. [PMID: 28697852 DOI: 10.1016/j.jpedsurg.2017.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/30/2017] [Accepted: 06/23/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Childhood obesity has become a serious public health problem in our country with a prevalence that is disproportionately higher among minority groups. Laparoscopic sleeve gastrectomy (LSG) is gaining attention as a safe bariatric alternative for severely obese adolescents. STUDY DESIGN A retrospective study on morbidly obese adolescents that underwent LSG at our institution from 2009 to 2017. Primary outcomes were weight loss as measured by change in BMI and percent excess weight loss (%EWL) at 1 year after surgery, resolution of comorbidities and occurrence of complications. RESULTS Thirty-eight patients, of whom 71% were female and 74% were ethnic minorities, underwent LSG between 2009 and 2016. Mean age was 16.8years, mean weight was 132.0kg and mean BMI was 46.7. There were no surgical complications. Mean %EWL was 19.4%, 27.9%, 37.4%, 44.9%, and 47.7% at 1.5, 3, 6, 9, and 12month follow up visits, respectively. Comorbidity resolution rates were 100% for hypertension and nonalcoholic fatty liver disease, 91% for diabetes, 44% for prediabetes, 82% for dyslipidemia and 89% for OSA. CONCLUSIONS LSG is an effective and safe method of treatment of morbid obesity in adolescents as it can significantly decrease excess body weight and resolve comorbid conditions. Further studies are needed to investigate the long-term effects of LSG in adolescents. CLINICAL RESEARCH STUDY Descriptive case series with prospective database. LEVEL OF EVIDENCE IV.
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Ejaz A, Patel P, Gonzalez-Heredia R, Holterman M, Elli EF, Kanard R. Laparoscopic sleeve gastrectomy as first-line surgical treatment for morbid obesity among adolescents. J Pediatr Surg 2017; 52:544-548. [PMID: 27637140 DOI: 10.1016/j.jpedsurg.2016.08.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/18/2016] [Accepted: 08/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The increasing prevalence of obesity has necessitated the increasing use of bariatric surgery in the adolescent population. Outcomes following laparoscopic sleeve gastrectomy (LSG) among adolescents, however, have not been well-studied. We report outcomes following LSG as a first-line surgical therapy in patients under 21years of age. METHODS All patients who underwent LSG as a primary surgical option for morbid obesity were identified at the University of Illinois at Chicago between 2006 and 2014. Standard clinicopathologic and outcomes data were recorded. RESULTS We identified 18 patients (13 females, 5 males) who underwent LSG. Mean patient age was 17.8±1.7years. Mean BMI among all patients was 48.6±7.2kg/m2 and did not differ by gender (P=0.68). One patient (5.6%) experienced a 30-day perioperative complication (pulmonary embolism). Median LOS following LSG was 3days (IQR: 2, 3). 2 patients (11.1%) were readmitted within 30-days because of feeding intolerance that resolved without invasive intervention. At a median follow-up of 10.6 (range: 0-38) months, percent excess weight loss (%EWL) among all patients was 35.6%. Among patients with at least 2years follow-up (n=3), %EWL was 50.2%. CONCLUSIONS Laparoscopic sleeve gastrectomy in morbidly obese adolescents is a safe and feasible option. Short- and long-term weight loss appears to be successful following LSG. As such, LSG should be strongly considered as a primary surgical treatment option for all morbidly obese adolescents. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Aslam Ejaz
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL.
| | - Pankti Patel
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL
| | - Raquel Gonzalez-Heredia
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL
| | - Mark Holterman
- University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Enrique F Elli
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL
| | - Robert Kanard
- University of Illinois College of Medicine at Peoria, Peoria, IL
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Abstract
Obesity and diabetes represent twin health concerns in the developed world. Metabolic surgery has emerged as an established and enduring treatment for both obesity and diabetes. As the burden of obesity and diabetes varies upon the basis of ethnicity, it is also apparent that there may be differences for indications and outcomes for different ethnic groups after metabolic surgery. Whereas there appears to be evidence for variation in weight loss and complications for different ethnic groups, comorbidity remission particularly for diabetes appears to be free of ethnic disparity after metabolic surgery. The impacts of access, biology, culture, genetics, procedure, and socioeconomic status upon metabolic surgery outcomes are examined. Further refinement of the influence of ethnicity upon metabolic surgery outcomes is likely imminent.
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Affiliation(s)
- John Magaña Morton
- Section of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford, CA
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