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Comparative Study
. 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

Thomas H Inge  1 , R Yates Coley  2 , Lydia A Bazzano  3 , Stavra A Xanthakos  4 , Kathleen McTigue  5 , David Arterburn  2 , Neely Williams  6 , Rob Wellman  2 , Karen J Coleman  7 , Anita Courcoulas  8 , Nirav K Desai  9 , Jane Anau  2 , Roy Pardee  2 , Sengwee Toh  10 , Cheri Janning  11 , Andrea Cook  2 , Jessica Sturtevant  10 , Casie Horgan  10 , Ava J Zebrick  12 , Marc Michalsky  13 ; PCORnet Bariatric Study Collaborative
Affiliations
Comparative Study

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

Thomas H Inge et al. Surg Obes Relat Dis. 2018 Sep.

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.

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Figures

Fig. 1
Fig. 1
Flow diagram for identification of the adolescent PCORnet bariatric study cohort in 11 Clinical Data Research Networks.
Fig. 2
Fig. 2
Procedure prevalence over time. ∗Number and proportion of procedures observed through September 30, 2015.
Fig. 3
Fig. 3
Percentage change in body mass index through 3 years after bariatric surgery, by procedure type. ∗∗Sample sizes were insufficient for AGB to model 3 years of follow-up. This plot shows the estimated change in body mass index for the average patient. The intervals for RYGB and SG overlap here even though the difference was significant at 1 year because these curves also take into account uncertainty in the effect of other variables. AGB = adjustable gastric banding; RYGB = Roux-en-Y gastric bypass; and SG = sleeve gastrectomy.
Fig. 4
Fig. 4
Proportions of adolescent patients undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (AGB) with weight loss of > 5%, > 10%, > 20%, and > 30% at 1 and 3 ∗years, by procedure. ∗Sample sizes were insufficient for AGB to model 3 years of follow-up.
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