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Population survey

Rise in adolescent bariatric surgery stalls

Bariatric surgery in youths has failed to rise with the increasing number of obese children.
Similar number of bariatric operations performed in 2009 as in 2003
While comorbidities rise, complications remain low and hospital stay length decreases

The number of adolescent bariatric surgeries performed in the USA has plateaued in the last 10 years, with no increase in the number of operations performed since 2003, according to a new paper published in the Archives of Pediatrics and Adolescent Medicine.

While the rate of bariatric procedures increased from 0.8 per 100,000 US adolescents in 2000 to 2.3 per 100,000 in 2003, it remained steady in 2006 and 2009, with 2.2 operations per 100,000 and 2.4 operations per 100,000 respectively.

The research was carried out by Deirdre Kelleher and colleagues from the Children’s National Medical Centre, Washington, DC.

“Despite the suggestion that adolescent bariatric surgery has increased in popularity and continued to grow exponentially, inpatient surgery use leveled off from 2003 through 2009, reaching a plateau of about 1,000 procedures annually," say the authors.

The number of operations in the country has failed to keep pace with the rising number of obese adolescents in the country: there are three times as many overweight or obese children in the USA as there were in 1980.

However, while the amount of procedures remained steady, the type of operations performed changed significantly.

Open procedures were almost entirely replaced by laparoscopic procedures, and gastric bands became increasingly popular after they were approved for use in adults in 2001: by 2009, they accounted for around one-third of all operations.

This is despite the fact that adolescent gastric band surgery in the USA is limited to clinical trials performed in a small number of centres.

The number of gastric band operations performed on adolescents is likely to decline as Allergan have dropped their bid to get full marketing approval for the use of their Lap-Band in juveniles.

The authors found that most adolescent patients (defined as those aged between 10-19) were female, and over 17, although operations were performed on children as young as 12.

Complications remained rare, but while the prevalence of comorbidities increased from 49.3% in 2000 to 58.6% in 2009, the length of hospital stay decreased by around one day in the same period.

The main source of funding was private insurance, which accounted for 68.3% of operations in 2009; however, the number of operations funded by Medicare increased over the decade.

The researchers took their data from the Healthcare Cost and Utilization Project Kids’ Inpatient Database, which contains discharge data for juvenile hospital stays from 4,121 hospitals in 44 states.

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