O. Nunez Lopez1, D. Jupiter2, D. Adhikari2, R. S. Radhakrishnan1,3, K. A. Bowen-Jallow1 1University Of Texas Medical Branch,Surgery,Galveston, TX, USA 2University Of Texas Medical Branch,Preventive Medicine And Community Health,Galveston, TX, USA 3University Of Texas Medical Branch,Pediatrics,Galveston, TX, USA
Introduction:
Despite the increasing epidemic rates of adolescent obesity, the use of bariatric surgery in adolescents has plateaued since 2003. Sex and race disparities contribute to the underutilization of bariatric surgery. The use of different types of bariatric surgery has changed over time. In order to better understand the underutilization of adolescent bariatric surgery, we set out to identify potential factors that can impact treatment cost and influence the type of bariatric procedure used in adolescents.
Methods:
We used the Kid’s Inpatient Database, a nationwide population-based survey from 2006, 2009, and 2012. Adolescents (age 10-19 years) with a primary diagnosis of obesity who underwent bariatric surgery were identified. Univariate and bivariate analysis were computed. Multinomial logistic and linear regression were used to determine the association of the predictor variables with type of bariatric procedure, treatment cost and length of hospital stay (LOS), respectively. Income was represented by quartiles (Q1-lowest, Q4-highest), self-pay status included self-pay/uninsured patients, other payer status included federal and non-federal programs.
Results:
1,799 adolescents underwent bariatric surgery. The majority of the subjects were female 77% (n=1,379). Mean age was 18 ± 1 years. Whites represented 60% (n=1,076), Blacks 13% (n=234), Hispanics 20% (n=359) and other races 7% (n=130). The most commonly performed procedure was gastric bypass (GB) (56%, n=993), followed by sleeve gastrectomy (SG) (23%, n=429) and adjustable gastric banding (AGB) (21%, n=377). Several sociodemographic characteristics are associated with specific type of bariatric procedure (Table 1). Hispanics were less likely to undergo AGB (OR 0.5; 95% CI 0.3-0.8); self-pay patients were less likely to undergo GB (OR 0.5; 95% CI 0.3-0.7), and patients with other payer type were more likely to undergo GB (OR 6; 95% CI 2.4-14.9) and AGB (OR 10.1; 95% CI 3.6-28.7), all as compared to SG. LOS was not affected by the variables analyzed. Overall, treatment cost was decreased by low income (Q1, Q2), teaching status and large hospital size. Stratification by type of surgery showed that GB cost was decreased by low income (Q1, Q2); AGB cost was reduced by female sex and large hospital size; and SG cost was reduced by large hospital size and teaching status.
Conclusion:
Primary payer, hospital region and teaching status play a role in the type of procedure performed. Income, teaching status, and hospital size are determinants of treatment cost. Understanding factors associated with the use of suboptimal procedures can identify opportunities for change of practice. Identifying factors that decrease treatment cost can improve access to surgical care.
