Damian McNamara

November 07, 2013

ORLANDO, Florida — Despite evidence supporting bariatric surgery as a safe and effective strategy to improve the health of morbidly obese children and teens, only 2% of patients undergo these procedures, a large database study reveals.

"Sometimes pediatricians are hesitant to refer to bariatric surgery because of concerns about overall development, bone health, and mental health," Nathan Zwintscher, MD, from Madigan Army Medical Center in Tacoma, Washington, told Medscape Medical News. "Bariatric surgery has been shown to be safe. It presents an opportunity to intervene earlier and avoid complications of obesity such as diabetes, sleep apnea, and high blood pressure."

Dr. Zwintscher presented the results here at the American Academy of Pediatrics (AAP) 2013 National Conference and Exhibition.

"Remember that 80% of morbidly obese children become morbidly obese adults," he told the audience.

To find out more about pediatric bariatric surgery prevalence and trends, Dr. Zwintscher and his team looked at bariatric surgery rates from the Kids' Inpatient Database, a nationally representative compilation of admissions.

They identified 1615 hospitalizations for children undergoing bariatric surgery for morbid obesity, representing just 2% of the 78,649 obese children in the database.

Average age at time of bariatric surgery was 18.5 years, although the study included obese patients aged 7 to 20 years.

Bariatric surgery remains "uncommon and underutilized" in this population despite low complication rates, Dr. Zwintscher said; however, surgery rates did increase from 771 procedures in 2003 to 1609 in 2009.

Table. Comparison of Different Bariatric Surgery Approaches in Children

Gastric Surgery Patients (n) Length of Stay (Days) Complication Rate (%)

Laparoscopic bypass

906 2.20 3.5

Laparoscopic banding

445 1.02 0.2

Sleeve gastrectomy

150 2.33 0.7

Open bypass

90 2.44 3.3

Laparoscopic gastroplasty

18 1.10 0


"We're seeing sleeve gastrectomy becoming more popular, perhaps because it does not involve rerouting the intestines," said Dr. Zwintscher.

Investigators identified procedures and complications using the International Classification of Diseases, Ninth Revision (ICD-9) codes, a limitation of the study. The inpatient database also does not include complications that occur after discharge.

Asked by Medscape Medical News to comment on the work, Sandra Hassink, MD, a pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, and chair of the AAP Obesity Leadership Workgroup, said, "This research emphasizes the desire clinicians have to find options for their kids with very high BMIs."

She explained, "Underutilization is a problem not previously characterized in bariatric surgery for a host of reasons. We don't know the long-term outcomes of bariatric surgery in adolescents. We don't have long-term predictors of who will succeed. A whole program is needed to meet the needs of all these children."

Dr. Zwintscher said he agrees that any decision to proceed with bariatric surgery in this pediatric population should be based on a multidisciplinary evaluation. "No one pediatrician or surgeon should make the decision alone," he emphasized.

Dr. Zwintscher and Dr. Hassink report no relevant financial relationships. Dr. Zwintscher's opinions are his own and do not represent the views of the Department of the Army or the US Department of Defense.

American Academy of Pediatrics (AAP) 2013 National Conference and Exhibition: Abstract 16. Presented October 25, 2013.


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