From the Journals

Rates of health care use after bariatric surgery in teens



Sleeve gastrectomy may have an advantage over gastric bypass in terms of postprocedure health care use, according to a study of Medicaid-insured adolescents with severe obesity.

Researchers found significantly lower rates of both emergency department (ED) use and hospitalization 5 years after sleeve gastrectomy compared with gastric bypass, and similarly low rates of adverse events.

Comparative outcomes for weight-loss procedures in adolescents

The study, by researchers with the department of surgery and Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, was published in JAMA.

Studies have shown that sleeve gastrectomy and gastric bypass both lead to significant weight loss and are associated with low complication rates among adolescents with severe obesity.

Until now, however, comparative outcomes for these two weight-loss procedures have not been described for adolescents insured by Medicaid, the largest insurer of adolescents in the United States.

Using Medicaid claims data, Ryan Howard, MD, and colleagues identified 855 adolescents who underwent sleeve gastrectomy and 277 who underwent Roux-en-Y gastric bypass between 2012 and 2018.

Adolescents in both groups were about 18 years old on average at the time of surgery, and about three-quarters were female.

Sleeve gastrectomy became more common over the study period. The annual percentage of sleeve gastrectomy relative to gastric bypass increased from 48.8% in 2012 to 82.6% in 2018.

There was no significant difference in rates of complications (P = .31) or reoperation (P = .78), defined as abdominal operation potentially related to the index procedure, including biliary procedures and abdominal wall, internal, and paraesophageal hernia repair.

Researchers also found no difference between sleeve gastrectomy and gastric bypass in rates of death (P = .42) or revision (P = .63), which included any operation that directly modified the index procedure.

The results “may help inform the treatment of severe obesity in adolescents insured by Medicaid, although future studies should also evaluate long-term weight loss and comorbidity resolution in this population,” Dr. Howard and colleagues write.

They caution that their analysis is subject to selection bias because patient characteristics may influence the choice of procedure, although appropriate statistical adjustment was used.

Other limitations include the small sample size, which increases the possibility of type II error; the relatively short follow-up period; and the inability to directly attribute outcomes to the index procedure.

Funding for the study was provided by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. The authors have disclosed no relevant financial relationships.

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