Trends in Volume and Utilization Outcomes in Adolescent Metabolic and Bariatric Surgery at Children's Hospitals

摘要

Purpose: As the prevalence of obesity increases in adolescents, the rate of metabolic and bariatric surgery (MBS) is also rising. Little is known about MBS rates at children's hospitals. This study describes trends in adolescent MBS volume and examines hospital resource utilization among patients undergoing MBS at children's hospitals. Methods: We performed a retrospective cohort study using a large pediatric hospital database (Inpatient Essentials database) to identify adolescents aged 10e18 years who underwent MBS from 2012 to 2016. Procedures were identified based on the presence of diagnosis codes for obesity and bariatric surgery. Our primary outcome was annual MBS volume, and secondary outcomes included cost, length of stay (LOS), and 30-day readmission rates. Results: A total of 859 adolescents from 39 children's hospitals underwent MBS during the study timeframe. Included patients were typically aged > 16 years (49.7%), female (73.3%), and nonHispanic white (50.5%). The number of bariatric surgeries increased 1.8-fold, from 126 in 2012 to 220 in 2016 (p 1/4 .004). There was considerable variation in the number of procedures by hospital, ranging from 1 to 159, with a median of 4 (interquartile range: 1e18) procedures per hospital. As the annual number of surgeries increased, LOS decreased by 1 day (p 1/4 .028) and cost decreased by 22% (p .925). Conclusion: MBS rates are increasing in children's hospitals, whereas LOS and cost are decreasing, without affecting readmission rates. These findings may be useful for development of quality benchmarks for developing and existing MBS programs within children's hospitals. (C) 2019 Society for Adolescent Health and Medicine. All rights reserved.