N. V. Mulpuri2, E. C. Victor1,3, G. P. Wools1, M. Lott1,3, F. G. Qureshi1,2 1Children’s Medical Center,Pediatric Surgery,Dallas, Tx, USA 2University Of Texas Southwestern Medical Center,Department Of Surgery,Dallas, TX, USA 3University Of Texas Southwestern Medical Center,Department Of Psychiatry,Dallas, TX, USA
Introduction: Bariatric surgery has been used to treat severe obesity in adolescents. However, only a limited number of adolescents referred to surgery successfully complete the surgical program. Better identification of pre-surgical factors associated with completing bariatric surgery may determine successful referrals to surgical programs versus alternative behavioral health interventions.
Methods: A retrospective chart review of all patients referred from 2015 to 2018 to an adolescent surgical weight loss program was performed. Pre-operative factors, weight loss, and resolution of premorbid conditions among surgery completers (n=47) was compared to surgery non-completers (n=149) using backward stepwise logistic regression. Choice of procedure was laparoscopic sleeve gastrectomy. IRB approval was obtained.
Results:196 adolescents were identified (17.1±1.61 yrs, body mass index (BMI) 50.2±8.8kg/m2, 66% female). 47 (24%) underwent sleeve gastrectomy (age (17.6±1.16 yrs, BMI 50.71±7.50kg/m2, 78% female) and 149 (16.2±1.51 yrs, body mass index (BMI) 49.98±9.19kg/m2, 62% female)) did not complete the surgical program. There was no difference between completers and non-completers in terms of age, race, ethnicity, BMI, premorbid medical conditions (hypertension, fatty liver disease, type 2 diabetes, hyperlipidemia), current or past mental health diagnosis, insurance type, referral source, or family history of weight loss surgery at surgical referral. Regression analyses revealed that boys (p=.045), patients with sleep apnea (OSA p=.009), and those that spent shorter time in the preoperative phase of the bariatric program (p<.001) were significantly more likely to have surgery. Surgery completers lost weight successfully (figure 1) p<0.05
Conclusion:The conversion rate from adolescent referral to weight loss surgery is 24%. Male patients, and patients with OSA are more likely to undergo weight loss surgery. Patients who make significant changes upon surgical referral spend less time in the preoperative phase and are more likely to complete surgery. Laparoscopic sleeve gastrectomy is successful in helping completers lose significant weight. These factors may help streamline referrals to adolescent surgical weight loss programs.
