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Modern Trends in Pediatric Metabolic and Bariatric Surgery
Zachary Ballinger
1, Hayley Reddington
1, Muriel Cleary
2, Jonathan Green
2, Kaitlyn Wong
2, Nicole Cherng
2, Jeremy Aidlen
2
1UMass Chan Medical School, Worcester, MA, 2 UMass Memorial Medical Center, Worcester, MA
Background: Early intervention in pediatric patients with Metabolic and Bariatric Surgery (MBS) is safe and superior to medical treatment for achieving weight loss and comorbidity reduction. Prior studies suggest MBS is limited to older children. Adjusted eligibility criteria have lowered age limits and expanded access. This study examines pediatric MBS throughout recent policy changes.
Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database identified children aged 10-17 who underwent MBS from 2017-2022.
Results: From 2017-2022, 2229 pediatric patients underwent MBS. 70% were female, 59% were white, and average age was 16.1 years. There were no significant differences in age and sex distributions by year. BMI at surgery did not vary with age. Diabetes was more prevalent in older patients, whereas sleep apnea was more common in younger patients. Females had lower BMI at surgery and higher rates of robotic-assisted surgery. Case volume decreased with COVID and rapidly increased thereafter (Figure 1). Sleeve gastrectomy increased in relative prevalence compared to bypass, and robotic-assisted cases are increasing twice as fast as laparoscopic procedures. Post-operative swallow studies, drains, and leak tests are decreasing. The overall complication rate was 2.9%, with dehydration being most common. Readmission, re-operation, and re-intervention did not vary by year.
Conclusion: MBS remains a safe treatment option for pediatric obesity with all ages having similar outcomes. Despite recent efforts to expand care to younger patients, the majority of pediatric MBS is performed for white, female patients age 16-17. Cases have returned to pre-pandemic levels, with robotic-assisted cases increasing.
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