Perioperative Outcomes in Adolescent Bariatric SurgeryThursday, November 7, 2013
While this raises all kinds of issues around the actual clinical management of these youngsters, an immediate concern is whether or not the surgery itself poses any immediate dangers.
This was assessed in a paper by Thomas Inge and colleagues from Cincinnati Children’s Hospital Medical Center, Ohio, published in JAMA Pediatrics.
The paper describes the perioperative outcomes (within 30 days of surgery) in 242 consecutive patients aged 19 years or younger who were approved to undergo bariatric surgery at five US academic referral centres, who agreed to participate in this prospective study.
The mean age of participants was 17 years and the median body mass index was 50, half of who had four or more comorbid conditions.
Participants underwent different surgical procedures, including laparoscopic Roux-en-Y gastric bypass (66%), vertical sleeve gastrectomy (28%), and adjustable gastric banding (6%).
Although there were no deaths during the initial hospitalization or within 30 days of operation, 19 (8%) of participants experienced major complications (eg, reoperation), while 36 (15%) experienced minor complications (eg, readmission for dehydration).
These numbers are significantly higher than those seen in experienced high-volume adult surgical programs and may point to specific issues in this younger patient population (no good explanations are provided in the paper and I wonder if my readers have any thoughts on why this may be the case).
While this study certainly demonstrates significant room for improvement around the perioperative management of adolescents with severe obesity, it does not address the even more important issue of long-term outcomes.
Although, I am certain, that the vast majority of adolescents will quickly experience as many (if not more) benefits in term of remission or even resolution of cormobidities and marked improvements in quality of life, we really do not (yet) know the long-term benefits of this treatment in this population.
Thus, at this time, adolescent bariatric surgery is clearly far from being considered routine and each case must be carefully considered and evaluated both in terms of indications, perioperative management and long-term outcomes.
Hat tip to Kristi for alerting me to this study.
Inge TH, Zeller MH, Jenkins TM, Helmrath M, Brandt ML, Michalsky MP, Harmon CM, Courcoulas A, Horlick M, Xanthakos SA, Dolan L, Mitsnefes M, Barnett SJ, Buncher R, & for the Teen-LABS Consortium (2013). Perioperative Outcomes of Adolescents Undergoing Bariatric Surgery: The Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study. JAMA pediatrics PMID: 24189578