Despite increased numbers of obese adolescents, the number of inpatient bariatric surgery cases has plateaued (JAMA Pediatr 2013; 167: 126-32). Thanks to Ben Gold for sharing this reference.
In this retrospective cross-sectional study using an administrative dataset (Healthcare Cost and Utilization Project Kids’ Inpatient Database), the authors documented the following bariatric surgery rates:
- In 2000: 0.8 per 100,000 (328 procedures)
- In 2003: 2.3 per 100,000 (987 procedures)
- In 2006: 2.2 per 100,000 (925 procedures)
- In 2009: 2.4 per 100,000 (1009 procedures)
The other observations in this study were that procedures were predominantly performed on females (75%), the prevalence of comorbidites increased (49% in 2003 vs. 59% in 2009), and complications rates were low. 68.3% had private insurance.
The number of adolescents who would qualify for bariatric surgery has increased but the rates have not changed. Why?
- Societal barriers. Obesity is more common in lower socioeconomic groups with lower educational levels. Yet, the rates of bariatric procedures is the same in low-income and high-income populations.
- Insurance coverage. In many states, medicaid does not cover bariatric surgery.
- Physicians limiting access. After initial enthusiasm (2000-2003), published guidelines to identify appropriate patients and to highlight recommendations prior to surgery may have led to more cautious referral patterns.
Over the past decade, there are increased numbers of qualified surgeons and there has been more use of laparascopic techniques. The Roux-en-Y gastric bypass (RYGB) was the most common bariatric procedure in this population, accounting for 67.6% of cases in 2009 (60.6% were laparascopic, 7% were open). Laparascopic adjustable gastric banding (LAGB) accounted for the remaining 32.1% of cases.
Since this study relied on administrative data, there are several limitations. Billing codes may not reflect the procedures accurately. For example, ICD-9 codes for laparascopic sleeve gastrectomy were not available until 2011. Nevertheless, this study provides some insight into the trends with bariatric procedures in adolescents.
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