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Plateaued Utilization of Adolescent Bariatric Surgery Despite Increasing Prevalence of Obesity-Associated Co-Morbidities: a National Inpatient Sample Trends Analysis
Tammy L. Kindel*, Daniel Lomelin, Vishal Kothari, Dmitry Oleynikov
Surgery, University of Nebraska Medical Center, Omaha, NE
Introduction: The number of adolescent bariatric surgeries (ABS) performed annually from 2003-09 has been stable despite numerous reports of the increase in adolescent morbid obesity. We sought to determine the recent trend in ABS volume given recent publications citing the detrimental impact of childhood obesity on adult co-morbidities. In addition, we examined the changes in obesity-associated co-morbidities (OACMs) over time for adolescents undergoing bariatric surgery.
Methods: The National Inpatient Sample (NIS) database was queried from 2004-11 for the following surgery by ICD-9 code: Roux-en-y Gastric Bypass (RYGB), Adjustable Gastric Band (AGB), and Sleeve Gastrectomy (SG) with a diagnosis code for obesity and 10-19 years of age. The NIS case volumes were subcategorized by 2 year periods (2004-05, 2006-07, 2008-09, 2010-11). Thirteen OACM categories were created by ICD-9 code. Fractional weights were calculated and applied from the NIS supplied discharge weights to retain proportionality of the original weighing scheme while preserving the actual sample size. National estimates utilized the supplied NIS weights. All statistics were calculated using IBM SPSS v. 22.0.0.0.
Results: From 2004-11, national estimates from the NIS indicate an average of 988 cases/year were performed with no statistical change in yearly volumes. There was a significant decrease in the number of RYGBs performed yearly (81.4% to 54.2%, p<0.001) with a significant increase in the number of AGB (12.9% to 18.8%, p=0.002) and SG (0.7% to 26.6%, p<0.001). The median patient age was 18 years old (range 12-19 years old) with 76% females. The average number of OACMs per adolescent increased significantly over time from 1.44 ± 1.3 in 2004-05 to 1.85 ±1.5 in 2010-11 (p<0.001) with no significant difference based on the surgery type performed. From 2004 to 2011, there was a significant increase in the number of patients with a pre-operative OACM diagnosis of hypertension (16.6% to 24.2%, p=.006), hyperlipidemia (10.2% to 15.4%, p=.021), obstructive sleep apnea (OSA, 15.6% to 26.8%, p<0.001) and non-alcoholic fatty liver disease (NAFLD, 5.2% to 10.5%, p=.004), Table 1. The average LOS decreased significantly over time from 2.33 ± 1.5 days in 2004-05 to 2.07 ± 1.3 in 2010-11. There was zero reported mortality.
Conclusions: There is a significant increase in the number of OACMs for adolescents undergoing bariatric surgery, specifically hypertension, hyperlipidemia, OSA and NAFLD. Despite the increase in OACMs, there has not been a concomitant increase in the number of ABS performed. Given the increased prevalence of OACMs, this data supports efforts to address barriers to adolescent bariatric surgical evaluation and treatment.
Obesity-associated Co-Morbidities over Time
| 2004-05 | 2006-07 | 2008-09 | 2010-11 | Overall (n) | p* | | Cardiac | 0 | 1 (0.3%) | 0 | 1 (0.3%) | 2 | 0.546 | | Hyperlipidemia | 45 (10.2%) | 41 (12.5%) | 56 (13.6%) | 65 (15.4%) | 207 | 0.021 | | GERD | 93 (21.1%) | 92 (28.1%) | 106 (25.7%) | 102 (24.2%) | 393 | 0.383 | | Respiratory | 75 (17.0%) | 57 (17.4%) | 80 (19.4%) | 78 (18.5%) | 290 | 0.442 | | OSA | 69 (15.6%) | 68 (20.8%) | 93 (22.5%) | 113 (26.8%) | 343 | <0.001 | | Diabetes | 52 (11.8%) | 34 (10.4%) | 42 (10.2%) | 65 (15.4%) | 193 | 0.144 | | PCOS | 21 (4.8%) | 21 (6.4%) | 20 (4.8%) | 36 (8.6%) | 98 | 0.055 | | Metabolic Syndrome | 6 (1.4%) | 9 (2.8%) | 12 (2.9%) | 13 (3.1%) | 40 | 0.105 | | Endocrine | 20 (4.5%) | 13 (4.0%) | 26 (6.3%) | 21 (5.0%) | 80 | 0.464 | | Psychiatric | 61 (13.8%) | 38 (11.6%) | 49 (11.9%) | 68 (16.2%) | 216 | 0.366 | | NAFLD | 23 (5.2%) | 26 (8.0%) | 37 (9.0%) | 44 (10.5%) | 130 | 0.004 | | Musculoskeletal | 96 (21.8%) | 65 (19.9%) | 102 (24.7%) | 72 (17.1%) | 335 | 0.281 | | Hypertension | 73 (16.6%) | 61 (18.7%) | 79 (19.1%) | 102 (24.2%) | 315 | 0.006 |
*Tested using the linear-by-linear association test for trend.
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