Why isn't bariatric surgery for adolescents catching on?

OBJECTIVES: To determine the current rate of inpatient bariatric surgical procedures among adolescents and to analyze national trends of use from 2000 to 2009. DESIGN: Retrospective cross-sectional study. SETTING: Discharge data obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database, 2000 through 2009. PARTICIPANTS: Adolescents (defined herein as individuals aged 10-19 years) undergoing inpatient bariatric procedures. INTERVENTION: Inpatient bariatric surgery. MAIN OUTCOME MEASURES: The primary outcome measure was the national population-based bariatric procedure rate. The secondary outcome measures were trends in procedure rates and type, demographics, complication rate, length of stay, and hospital charges from 2000 through 2009. RESULTS: The inpatient bariatric procedure rate increased from 0.8 per 100,000 in 2000 to 2.3 per 100,000 in 2003 (328 vs 987 procedures) but did not change significantly in 2006 (2.2 per 100,000) or 2009 (2.4 per 100,000), with 925 vs. 1009 procedures. The use of laparoscopic adjustable gastric banding approached one-third (32.1%) of all procedures by 2009. The cohort was predominantly female and older than 17 years. The prevalence of comorbidities increased from 2003 (49.3%) to 2009 (58.6%) (P = .002), while the complication rate remained low and the in-hospital length of stay decreased by approximately 1 day (P < .001). Increasing numbers of patients had Medicaid as their primary payer source; however, most (68.3% in 2009) had private insurance. CONCLUSIONS: Despite the worsening childhood obesity epidemic, the rate of inpatient bariatric procedures among adolescents has plateaued since 2003. The predominant procedure type has changed to minimally invasive techniques, including laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Trends show low complication rates and decreasing length of stay, despite increasing comorbid conditions among patients.

The long-term risk of venous thromboembolism following bariatric surgery.

BACKGROUND: Venous thromboembolism (VTE) is a leading cause of morbidity and mortality following bariatric surgery. The exact duration and magnitude of post-surgery risk for VTE, however, is unclear. We analyzed a large administrative database to determine the long-term risk and predictors for VTE in patients undergoing bariatric surgery. METHODS: A private insurance claims database was used to identify 17,434 patients who underwent bariatric surgery. Longitudinal data were available for each patient for up to 12 months post-surgery. We used logistic regression to identify independent predictors for VTE events. RESULTS: The incidence of VTE during the index surgical hospitalization was .88%. This cumulative rate rose to 2.17% at 1 month and 2.99% by 6 months post-surgery. Over 74% of VTE events occurred after discharge. Risk factors identified for VTE developing by 6 months post-surgery included male sex (odds ratio (OR) = 1.68; confidence limits (CL) = 1.37-2.07), age ≥ 55 years (OR = 2.18; CL = 1.56-3.03), smoking (OR = 1.86; CL = 1.06-3.27), and previous VTE (OR = 7.48; CL = 5.78-9.67). The laparoscopic adjustable gastric band was less likely to result in VTE compared to open or laparoscopic gastric bypass (OR = .31; CL = .13-.75). CONCLUSIONS: The period of increased risk for VTE following bariatric surgery extends well beyond the initial hospital discharge and 30 days after surgery. The high frequency of VTE up to 6 months following bariatric surgery suggests that more aggressively extended prophylaxis should be considered in patients at higher risk for VTE.