Background

The prevalence of childhood obesity in the U.S. has tripled over the last three decades. However, fewer than 1% of children with severe obesity undergo surgical weight loss interventions each year.

Materials and methods

All patients age 10 to 19 years old who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2015 through 2018 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database were included in this retrospective cohort analysis. The primary outcomes were mortality and overall complications. Procedural trends, readmission and reoperation rates were also examined using a multivariate regression model.

Results

Patients had a mean BMI of 47.3 kg/m² and 80.0% were either 18 or 19 years old (n = 4,051). There were two reported deaths. Reoperation within 30 days occurred in 1.1% of patients, readmission in 3.5%, and complications in 1.2%. Among all readmissions, primary reasons included nausea/vomiting or nutritional depletion (41.3%) and abdominal pain (16.3%). RYGB was associated with higher odds for readmission (p = 0.006) and complications (p = 0.005). Higher BMI and younger age were not associated with an increased likelihood to experience poorer outcomes. The proportion of patients undergoing SG increased yearly over RYGB from 73.9% in 2015 to 84.3% in 2018.

Conclusions

Bariatric surgery appears to be low risk for adolescents and SG has become the operation of choice. More research on early consideration of surgical therapy in adolescents with severe obesity is needed given the safety profile.

Level of Evidence

III

中文翻译：

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青少年减肥手术有多安全？短期结果分析

背景

在过去的三十年里，美国儿童肥胖症的患病率增加了两倍。然而，每年只有不到 1% 的重度肥胖儿童接受手术减肥干预。

材料和方法

2015 年至 2018 年在代谢和减肥手术认证和质量改进计划数据库中接受腹腔镜 Roux-en-Y 胃旁路术 (RYGB) 或袖状胃切除术 (SG) 的所有 10 至 19 岁患者均被纳入该回顾性队列分析. 主要结局是死亡率和总体并发症。还使用多元回归模型检查了手术趋势、再入院率和再手术率。

结果

患者的平均 BMI 为 47.3 kg/m ²且 80.0% 为 18 或 19 岁（n  = 4,051）。据报道有两人死亡。1.1% 的患者在 30 天内再次手术，3.5% 的患者再入院，1.2% 的并发症发生。在所有再入院中，主要原因包括恶心/呕吐或营养不足（41.3%）和腹痛（16.3%）。RYGB 与更高的再入院几率（p  = 0.006）和并发症（p  = 0.005）相关。较高的 BMI 和较年轻的年龄与经历较差结果的可能性增加无关。接受 SG 的患者比例每年超过 RYGB，从 2015 年的 73.9% 增加到 2018 年的 84.3%。

结论

减肥手术似乎对青少年的风险较低，而 SG 已成为首选手术。考虑到安全性，需要对严重肥胖的青少年早期考虑手术治疗进行更多研究。

证据水平

三