Original article
Health Disparities in Adolescent Bariatric Surgery: Nationwide Outcomes and Utilization

https://doi.org/10.1016/j.jadohealth.2017.05.028Get rights and content

Abstract

Purpose

Bariatric surgery represents an appropriate treatment for adolescent severe obesity, but its utilization remains low in this patient population. We studied the impact of race and sex on preoperative characteristics, outcomes, and utilization of adolescent bariatric surgery.

Methods

Retrospective analysis (2007–2014) of adolescent bariatric surgery using the Bariatric Outcomes Longitudinal Database, a national database that collects bariatric surgical care data. We assessed the relationships between baseline characteristics and outcomes (weight loss and remission of obesity-related conditions [ORCs]). Using the National Health and Nutrition Examination Survey and U.S. census data, we calculated the ratio of severe obesity and bariatric procedures among races and determined the ratio of ratios to assess for disparities.

Results

About 1,539 adolescents underwent bariatric surgery. Males had higher preoperative body mass index (BMI; 51.8 ± 10.5 vs. 47.1 ± 8.7, p < .001) and higher rates of obstructive sleep apnea and dyslipidemia. Blacks had higher preoperative BMI (52.4 ± 10.6 vs. 47.3 ± 8.3; 48.7 ± 8.8; 48.2 ± 12.1 kg/m2; whites, Hispanics, and others, respectively p < .001) and higher rates of hypertension, obstructive sleep apnea, and asthma. Weight loss and ORCs remission rates did not differ between sexes or races after accounting for the rate of severe obesity in each racial group. White adolescents underwent bariatric surgery at a higher proportion than blacks and Hispanics (2.5 and 2.3 times higher, respectively).

Conclusions

Preoperative characteristics vary according to race and sex. Race and sex do not impact 12-month weight loss or ORC's remission rates. Minority adolescents undergo bariatric surgery at lower-than-expected rates.

Section snippets

Participants and materials

Adolescents with age ≥12 to <19 years who underwent bariatric surgery were identified using the Bariatric Outcomes Longitudinal Database (BOLD), years 2007–2014. The BOLD, created by the Surgical Review Corporation, is a repository from the American Society for Metabolic and Bariatric Surgery–Bariatric Surgery Center of Excellence (BSCOE) participants [17]. BSCOE participants (563 centers, during the study period, distributed across the nation) entered prospective data for bariatric surgery

Baseline characteristics

We identified 1,539 adolescents who underwent bariatric surgery. Table 1 shows demographic characteristics, preoperative BMI, rates of ORCs, and the proportion of each type of bariatric procedure. Our sample demonstrated a greater proportion of females (76%; n = 1,176) and whites (63%; n = 962) undergoing bariatric surgery. The average age at surgery was 16.9 ± 2.6 years and the average preoperative BMI was 48.2 ± 9.4 kg/m2. The most common ORC was hypertension (57%; n = 821). Gastric bypass

Discussion

Our study explored the outcomes and utilization of adolescent bariatric surgery using a national comprehensive repository. The characteristics of our study population resemble those previously reported, in which female patients account for 75%–80% and whites represent 65%–79% of the adolescents who undergo bariatric surgery [18], [19].

There are baseline differences in demographics and ORCs observed across our study population both in sex and race stratification. For example, males have higher

Acknowledgments

The authors would like to thank the Surgical Review Corporation and the American Society for Metabolic and Bariatric Surgery–Bariatric Surgery Center of Excellence participants. A poster version of this work was presented at the 2016 Annual Clinical Congress of the American College of Surgeons.

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    Conflicts of Interest: The authors have no conflicts of interest to disclose.

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