National Trends in Adolescent Bariatric Surgical Procedures and Implications for Surgical Centers of Excellence
Received 24 January 2007; received in revised form 3 July 2007; accepted 23 July 2007. published online 18 October 2007.
Background
Bariatric surgery is indicated for severely obese adolescents who have failed nonsurgical treatment. Our objective was to examine national trends in the use of bariatric operations among adolescents.
Study Design
The Kids’ Inpatient Database was used to identify bariatric surgery patients in the pediatric population (age younger than 18 years) for 1997, 2000, and 2003. Patients were identified by procedure codes for bariatric operations with confirmatory diagnosis codes for obesity. Nationally representative estimates of trends in bariatric procedures, patient characteristics, hospital characteristics, and in-hospital complication rates were calculated. We augmented our analysis with the 2003 Nationwide Inpatient Sample, to ascertain hospitals’ overall bariatric surgical volume (adolescents and adults).
Results
From 1997 to 2003, the estimated number of adolescent bariatric procedures performed nationally increased 5-fold from 51 to 282 (p < 0.01). More than 100 hospitals performed bariatric procedures on adolescents in 2003, most of which (87%) performed 4 or fewer adolescent bariatric operations annually. Operations were predominantly performed in adult hospitals (85%). Although most hospitals had high overall bariatric operation volumes (> 200 bariatric procedures for patients of any age), 39% of adolescent bariatric procedures were performed at lower-volume centers. Patients were predominantly Caucasian (68%) and female (72%), with a mean age of 16 years (minimum age 12 years). In-hospital complications occurred in 6% of patients. There were no in-hospital deaths.
Conclusions
Our findings indicate a recent, rapid increase in the frequency of adolescent bariatric procedures. Most hospitals that performed bariatric procedures on adolescents had limited experience with adolescent bariatric patients, although many of these hospitals appear to have been experienced adult centers with high overall bariatric volume (adolescents and adults). Future research must better clarify the institutional qualifications considered mandatory for treatment of eligible adolescents.
aRWJ Clinical Scholars Program, University of Michigan, Ann Arbor, MI
bDivision of General Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
cChild Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI
dDivision of General Internal Medicine, University of Michigan, Ann Arbor, MI
eGerald R Ford School of Public Policy, University of Michigan, Ann Arbor, MI
fDivision of Pediatric Surgery, Department of Surgery, Lucile Packard Children’s Hospital, Stanford University Medical Center, Stanford, CA.
Correspondence address: Peter L Schilling, MD, RWJ Clinical Scholars Program, 6312 Medical Science Bldg I, 1150 W Medical Center Dr, Ann Arbor, MI 48109.
ABSTRACT