title: Plateaued national utilization of adolescent bariatric surgery despite increasing prevalence of obesity-associated co-morbidities.
abstract: BACKGROUND
  The number of adolescent bariatric surgeries (ABS) performed from 2003 to 2009 has been stable despite reports of an increase in adolescent morbid obesity.
  
  
  OBJECTIVE
  We sought to determine the trend in national ABS volume and the changes in obesity-associated co-morbidities (OACM) from 2004 to 2011.
  
  
  METHODS
  The Healthcare Cost and Utilization Project National Inpatient Sample database.
  
  
  METHODS
  The National Inpatient Sample database was queried for adolescents undergoing Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy from 2004 to 2011. Twelve OACM categories were created by ICD-9 code.
  
  
  RESULTS
  From 2004 to 2011, an estimated 968 ABS cases per year were performed with no significant change in yearly volumes. There was a significant decrease in the annual volume of Roux-en-Y gastric bypasses (85.7%-54.4%, P<.001) with a significant increase in the number of adjustable gastric bandings (13.6%-18.9%, P = .002) and sleeve gastrectomies (.7%-26.7%, P<.001). The mean patient age was 18.0±1.3 years, and 76% of patients were female. The average number of OACMs per adolescent increased significantly, from 1.44±1.3 in 2004-2005 to 1.85±1.5 in 2010-2011 (P<.001). There was a significant increase over time in the prevalence of preoperative obstructive sleep apnea (15.6%-26.8%, P<.001), hypertension (16.6%-24.2%, P = .006), hyperlipidemia (10.2%-15.4%, P = .021), and fatty liver disease (5.2%-10.5%, P = .004).
  
  
  CONCLUSIONS
  There was a significant increase in OACMs for patients undergoing ABS. Despite the increase in OACMs, there has not been a concomitant increase in the number of ABS performed as of 2011. Given the increase in OACMs, these data support efforts to address barriers to adolescent bariatric surgical evaluation and treatment.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: tkindel@mcw.edu.
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Kindel
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lomelin
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Corrigan
authors.initials: C
authors.lastname: McBride
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Vishal
authors.initials: V
authors.lastname: Kothari
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
mesh_terms: D000293:Adolescent; D050110:Bariatric Surgery / Q000706:statistics & numerical data*; D002648:Child; D005234:Fatty Liver / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology / Q000209:etiology; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D007902:Length of Stay; D008297:Male; D063766:Pediatric Obesity / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D015995:Prevalence; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology
keywords: Adolescent bariatric surgery; Co-morbidities; Fatty liver disease; Gastric bypass; Surgery utilization