Timing of bariatric surgery for severely obese adolescents: a Markov decision-analysis.
OBJECTIVE
Although controversial, bariatric surgery is increasingly being performed in adolescents. We developed a model to simulate the effect of timing of gastric bypass in obese adolescents on quantity and quality of life.


METHODS
A Markov state-transition model was constructed comparing two treatment strategies: gastric bypass surgery at age 16 versus delayed surgery in adulthood. The model simulated a hypothetical cohort of adolescents with body mass index of 45kg/m(2). Model inputs were derived from current literature. The main outcome measure was quality and quantity of life, measured using quality-adjusted life-years (QALYs).


RESULTS
For females, early gastric bypass surgery was favored by 2.02 QALYs compared to delaying surgery until age 35 (48.91 vs. 46.89 QALYs). The benefit was even greater for males, where early surgery was favored by 2.9 QALYs (48.30 vs. 45.40 QALYs). The absolute benefit of surgery at age 16 increased; the later surgery was delayed into adulthood. Sensitivity analyses demonstrated that adult surgery was favored only when the values for adverse events were unrealistically high.


CONCLUSIONS
In our model, early gastric bypass in obese adolescents improved both quality and quantity of life. These findings are useful for surgeons and pediatricians when counseling adolescents considering weight loss surgery.
The Dartmouth Institute of Health Policy & Clinical Practice, Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Lebanon, NH. Electronic address: Andrea.M.Stroud@hitchcock.org.
Andrea M
AM
Stroud
The Dartmouth Institute of Health Policy & Clinical Practice, Lebanon, NH.
Devin
D
Parker
Section of Pediatric Surgery, Department of Surgery, Geisel School of Medicine, Children's Hospital at Dartmouth, Dartmouth Hitchcock Medical Center, Lebanon, NH.
Daniel P
DP
Croitoru
D000293:Adolescent; D015992:Body Mass Index; D003661:Decision Support Techniques; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008390:Markov Chains; D009767:Obesity, Morbid / Q000601:surgery*; D063766:Pediatric Obesity / Q000601:surgery*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D016896:Treatment Outcome
Adolescents; Bariatric surgery; Decision analysis; Gastric bypass; Obesity