National Trends in Pediatric Metabolic and Bariatric Surgery: 2010-2017

BACKGROUND: The childhood obesity epidemic has grown exponentially and is known to disproportionately affect minority groups. Successful treatment of this complex health issue requires a multidisciplinary approach including metabolic and bariatric surgery (MBS) for qualifying pediatric patients. This study examines current national trends in pediatric bariatric surgery from 2010 to 2017 using the National Inpatient Sample. METHODS: This study analyzed MBS among pediatric patients <19 years old using weighted discharge data from 2010 to 2017. The primary outcome was national procedure rates. Secondary analyses included procedure type, demographics, BMI, comorbidities, length of stay, and complication rates. RESULTS: From 2010 to 2017, annual bariatric procedure rates increased from 2.29 to 4.62 per 100 000 (P< .001). Laparoscopic sleeve gastrectomy outpaced Roux-en-Y gastric bypass and laparoscopic adjustable gastric band over time (0.31-3.99 per 100 000, P< .0001). Themean age was stable over time 18.10-17.96 (P=.78). The cohortwas primarily female (76.5% to 75.4%), white (54.0% to 45.0%), and privately-insured (59.9% to 53.4%). Preoperative BMI increased from 2010 to 2017 (P< .001),whereas number of obesity-related comorbiditieswas stable (P> .05). Length of staywas<2 days (2.02-1.75, P=.04) and in-hospital complication rateswere low(7.2% to 6.45%, P=.88). CONCLUSIONS: PediatricMBS is underutilized nationallywith disproportionately lower rates among minority groups. Despite incremental progress, further investigation into the racial and social determinants that limit access to pediatricweight loss surgery is critical.