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Surg Obes Relat Dis. 2018 Sep;14(9):1374-1386. doi: 10.1016/j.soard.2018.04.002. Epub 2018 Apr 17.

Comparative effectiveness of bariatric procedures among adolescents: the PCORnet bariatric study.

Author information

1
Department of Surgery, University of Colorado, Denver, Aurora, Colorado; Children's Hospital of Colorado, Aurora, Colorado. Electronic address: thomas.inge@childrenscolorado.org.
2
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
3
Department of Epidemiology, Tulane University School of Public Health, New Orleans, Louisiana.
4
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
5
Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
6
Community Partners' Network, Nashville, Tennessee.
7
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
8
Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
9
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, Boston, Massachusetts.
10
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
11
Duke Clinical & Translational Science Institute, Durham, North Carolina.
12
REACHnet (a PCORnet CDRN), New Orleans, Louisiana.
13
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.

Abstract

BACKGROUND:

Bariatric surgery has been used for treatment of severe obesity in adolescents but most studies have been small and limited in follow-up.

OBJECTIVES:

We hypothesized that electronic health record data could be used to compare effectiveness of bariatric procedures in adolescents.

SETTING:

Data were obtained from clinical research networks using a common data model to extract data from each site.

METHODS:

Adolescents who underwent a primary bariatric procedure from 2005 through 2015 were identified. The percent change in body mass index (BMI) at 1, 3, and 5 years was estimated using random effects linear regression for patients undergoing all operations. Propensity score adjusted estimates and 95% confidence intervals were estimated for procedures with >25 patients at each time period.

RESULTS:

This cohort of 544 adolescents was predominantly female (79%) and White (66%), with mean (±standard deviation) age of 17.3 (±1.6) years and mean BMI of 49.8 (± 7.8) kg/m2. Procedures included Roux-en-Y gastric bypass (RYGB; n = 177), sleeve gastrectomy (SG; n = 306), and laparoscopic adjustable gastric banding (n = 61). For those undergoing RYGB, SG, and laparoscopic adjustable gastric banding, mean (95% confidence interval) BMI changes of -31% (-30% to -33%), -28% (-27% to -29%), and -10% (-8% to -12%), were estimated at 1 year. For RYGB and SG, BMI changes of -29% (-26% to -33%) and -25% (-22% to -28%) were estimated at 3 years.

CONCLUSIONS:

Adolescents undergoing SG and RYGB experienced greater declines in BMI at 1- and 3-year follow-up time points, while laparoscopic adjustable gastric banding was significantly less effective for BMI reduction.

KEYWORDS:

Adjustable gastric band; Adolescent; Bariatric; Gastric bypass; Outcome; Sleeve gastrectomy

PMID:
29793877
PMCID:
PMC6165694
[Available on 2019-09-01]
DOI:
10.1016/j.soard.2018.04.002
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