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

Thomas H Inge, R Yates Coley, Lydia A Bazzano, Stavra A Xanthakos, Kathleen McTigue, David Arterburn, Neely Williams, Rob Wellman, Karen J Coleman, Anita Courcoulas, Nirav K Desai, Jane Anau, Roy Pardee, Sengwee Toh, Cheri Janning, Andrea Cook, Jessica Sturtevant, Casie Horgan, Ava J Zebrick, Marc Michalsky, PCORnet Bariatric Study Collaborative, Thomas H Inge, R Yates Coley, Lydia A Bazzano, Stavra A Xanthakos, Kathleen McTigue, David Arterburn, Neely Williams, Rob Wellman, Karen J Coleman, Anita Courcoulas, Nirav K Desai, Jane Anau, Roy Pardee, Sengwee Toh, Cheri Janning, Andrea Cook, Jessica Sturtevant, Casie Horgan, Ava J Zebrick, Marc Michalsky, PCORnet Bariatric Study Collaborative

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.

Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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.

References

    1. Skinner AC, Perrin EM, Skelton JA. Prevalence of obesity and severe obesity in US children, 1999-2014. Obesity (Silver Spring) 2016;24(5):1116–23.
    1. Kelly AS, Barlow SE, Rao Gfor the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical Activity and Metabolism, and Council on Clinical Cardiology. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 2013;128(15):1689–712.
    1. Koebnick C, Smith N, Black MH, et al. Pediatric obesity and gallstone disease. J Pediatr Gastroenterol Nutr 2012;55(3):328–33.
    1. Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr 2007;150(1):e2.
    1. Skelton JA, Cook SR, Auinger P, Klein JD, Barlow SE. Prevalence and trends of severe obesity among US children and adolescents. Acad Pediatr 2009;9(5):322–9.
    1. Selewski DT, Collier DN, MacHardy J, et al. Promising insights into the health related quality of life for children with severe obesity. Health Qual Life Outcomes 2013;11:29.
    1. Schilling PL, Davis MM, Albanese CT, Dutta S, Morton J. National trends in adolescent bariatric surgical procedures and implications for surgical centers of excellence. J Am Coll Surg 2008;206(1):1–12.
    1. Tsai WS, Inge TH, Burd RS. Bariatric surgery in adolescents: recent national trends in use and in-hospital outcome. Arch Pediatr Adolesc Med 2007;161(3):217–21.
    1. Inge TH, Jenkins TM, Xanthakos SA, et al. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. Lancet Diabetes Endocrinol 2017;5(3):165–73.
    1. Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med 2016;374(2):113–23.
    1. Alqahtani A, Alamri H, Elahmedi M, Mohammed R. Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study. Surg Endosc 2012;26(11):3094–100.
    1. Zitsman JL, Fennoy I, Witt MA, Schauben J, Devlin M, Bessler M. Laparoscopic adjustable gastric banding in adolescents: short-term results. J Pediatr Surg 2011;46(1):157–62.
    1. Jen HC, Rickard DG, Shew SB, et al. Trends and outcomes of adolescent bariatric surgery in California, 2005-2007. Pediatrics 2010;126(4):e746–53.
    1. Fielding GA, Duncombe JE. Laparoscopic adjustable gastric banding in severely obese adolescents. Surg Obes Relat Dis 2005;1(4):399–405.
    1. Pallati P, Buettner S, Simorov A, Meyer A, Shaligram A, Oleynikov D. Trends in adolescent bariatric surgery evaluated by UHC database collection. Surg Endosc 2012;26(11):3077–81.
    1. Fleurence RL, Curtis LH, Califf RM, Platt R, Selby JV, Brown JS. Launching PCORnet, a national patient-centered clinical research network. J Am Med Inform Assoc 2014;21(4):578–82.
    1. Toh S, Rasmussen-Torvik LJ, Harmata EE, Pardee R, Saizan R, Malanga E, Sturtevant JL, Horgan CE, Anau J, Janning CD, Wellman RD, Coley RY, Cook AJ, Courcoulas AP, Coleman KJ, Williams NA, McTigue KM, Arterburn D, McClay J. PCORnet Bariatric Surgery Collaborative. The National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study Cohort: Rationale, Methods, and Baseline Characteristics. JMIR Res Protoc 2017. December 5;6(12):e222 10.2196/resprot.8323 PubMed PMID: 29208590; PubMed Central PMCID: PMC5736875.
    1. Gagne JJ, Glynn RJ, Avorn J, Levin R, Schneeweiss S. A combined comorbidity score predicted mortality in elderly patients better than existing scores. J Clin Epidemiol 2011;64(7):749–59.
    1. D’Agostino RB Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 1998;17(19):2265–81.
    1. Tibshirani R Regression shrinkage and selection via the lasso. J R Stat Series B Stat Methodol 1996;58(1):267–88.
    1. Laird NM, Ware JH. Random-effects models for longitudinal data. Biometrics 1982;38(4):963–74.
    1. Silverman BW. Some aspects of the spline smoothing approach to non-parametric regression curve fitting. J R Stat Series B Stat Methodol 1985;47(1):1–52.
    1. Little RJ, Rubin DB. Statistical Analysis With Missing Data, Hoboken, NJ: John Wiley & Sons; 2014. City.
    1. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr 2001;21:323–41.
    1. Inge TH, Zeller MH, Jenkins TM, et al. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr 2014;168(1):47–53.
    1. Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)-a prospective study. Obes Surg 2010;20(4):447–53.
    1. Alexandrou A, Armeni E, Kouskouni E, Tsoka E, Diamantis T, Lambrinoudaki I. Cross-sectional long-term micronutrient deficiencies after sleeve gastrectomy versus Roux-en-Y gastric bypass: a pilot study. Surg Obes Relat Dis 2014;10(2):262–8.
    1. Kwon Y, Kim HJ, Lo Menzo E, Park S, Szomstein S, Rosenthal RJ. Anemia, iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass: a meta-analysis. Surg Obes Relat Dis 2014;10(4):589–97.
    1. Li JF, Lai DD, Lin ZH, Jiang TY, Zhang AM, Dai JF. Comparison of the long-term results of Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis of randomized and nonrandomized trials. Surg Laparosc Endosc Percutan Tech 2014;24(4):1–11.
    1. Reames BN, Finks JF, Bacal D, Carlin AM, Dimick JB. Changes in bariatric surgery procedure use in Michigan, 2006-2013. JAMA 2014;312(9):959–61.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj