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Bariatric surgery as safe in adolescents as it is in adults

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Adolescent safety data are reassuring
Corrigan McBride, MD, professor of surgery and director of bariatric surgery, University of Nebraska Medical Center, Omaha

Dr. Corrigan McBride

These data are very important because they come from the largest collection of data on adolescents who underwent bariatric surgery at a U.S. center and are nationally representative. When I speak with families about the possibility of performing bariatric surgery on an adolescent, their overriding concern is the procedure’s safety. These numbers on adolescent safety constitute the first safety report for this demographic group from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. The similarity in the rate of adverse events in adolescents, compared with adults, is reassuring. As the database matures, we will get additional insights into the longer-term outcomes of these patients, information that’s very important for families trying to choose treatment for an obese adolescent child.

The comparison of safety outcomes between sleeve gastrectomy and Roux-en-Y gastric bypass appears to favor using sleeves. In obese adolescents the most common complications we see are nonalcoholic fatty liver disease and obstructive sleep apnea, and prior reports have documented that both often improve following sleeve gastrectomy. That fact, plus these new safety findings, may help push the field toward greater sleeve use in adolescents, although the data also show that sleeve gastrectomy is already used in nearly four-fifths of adolescent cases.

Corrigan McBride, MD, is a professor of surgery and director of bariatric surgery at the University of Nebraska Medical Center in Omaha. She had no disclosures. She made these comments in an interview.


 

REPORTING FROM OBESITY WEEK 2019

– Bariatric surgery in adolescents was about as safe as it was in adults in the largest U.S. database assembled so far for the procedure in this younger age group.

Keith J. King, MD, St. Luke's University Hospital, Allentown, Pa, standing at a podium. Mitchel L. Zoler/MDedge News

Dr. Keith J. King

The data from 1,983 patients aged 10-19 years who underwent bariatric surgery at an accredited U.S. center also showed, not unexpectedly, that laparoscopic sleeve gastrectomy was significantly safer during the perioperative and immediate postoperative periods, compared with the other main surgical option, laparoscopic Roux-en-Y gastric bypass.

The incidence of serious adverse events that occurred in adolescents either during surgery or in the 30 days after surgery was 2.9% in the 1,552 patients (78%) who underwent sleeve gastrectomy and 6.5% in the 431 (22%) patients who underwent gastric bypass, Keith J. King, MD, said at a meeting presented by the Obesity Society and the American Society for Metabolic and Bariatric Surgery.

Despite this safety disparity, “the decision to undergo sleeve gastrectomy or Roux-en-Y gastric bypass should be individualized to account for other factors, such as excess weight loss and long-term success,” said Dr. King, a bariatric surgeon at St. Luke’s Hospital, Allentown, Pa. But he acknowledged that having these recent safety data from a relatively large number of adolescents will help families that are trying to decide on treatment for their child.

The data came from records kept by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, begun in 2012 by the American College of Surgeons and the American Society for Bariatric and Metabolic Surgery, and a registry for every bariatric surgical procedure done at an accredited U.S. program. The database encompassed 840 surgical programs in 2019.

The incidence of perioperative and postoperative complications in the adolescent patients during the first 30 days after surgery was not statistically significant for any measured safety parameter, compared with 353,726 adults (at least 20 years old) enrolled in the same database during 2015-2017, except for the average duration of surgery, which was 8 minutes shorter in adolescents, Dr. King reported. The data showed that adolescents and adults had roughly similar rates of serious adverse events, organ space infections, and need for reoperation, intervention, or hospital readmission. The way in which clinicians applied bariatric surgery to adolescents also seemed similar to their use of the surgery in adults. The average body mass index of adult patients was about 45 kg/m2, and about 48 kg/m2 in adolescents, and in both age groups, nearly 80% of patients were women or girls.

In contrast, the comparison of sleeve gastrectomy and gastric bypass surgery in adolescents showed several statistically significant differences in safety and procedural characteristics. In addition to a more than twofold difference in the incidence of serious adverse events that favored the sleeve, the data also showed a twofold difference in the need for reoperation, 1% with the sleeve and 2% with bypass; and a threefold difference in the need for at least one intervention during 30-day follow-up, 1% in the sleeve recipients and 3% in those treated with gastric bypass. Patients required at least one hospital readmission within 30 days in 3% of the sleeve cases and in 6% of the bypass cases. Average hospital length of stay was 2 days in both groups.

An efficacy review from a different, large, U.S. database that included 544 adolescents who underwent bariatric surgery during 2005-2015 showed that at 3 years after surgery, average reductions in body mass index were 29% for patients who underwent gastric bypass and 25% in those treated with sleeve gastrectomy (Surg Obes Relat Dis. 2018;14[9]:1374-86).

The study received no commercial support. Dr. King had no disclosures.

SOURCE: El Chaar M et al. Obesity Week 2019, Abstract A138.

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