University of Texas Health Science Center, School of Public Health, Dallas, TX USA.
Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas.
Ann Surg. 2022 Aug 1;276(2):324-333. doi: 10.1097/SLA.0000000000004493. Epub 2020 Sep 15.
Class II (120% > body mass index [BMI] < 140% of the 95th percentile for age and sex) and Class III (BMI >140% of the 95th percentile for age and sex) obesity are the fastest growing subcategories of obesity in the United States pediatric population. Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for with class II/III obesity. The primary objectives of this analysis were to determine the (1) current US MBS utilization rates in those with class II/III obesity and (2) utilization rates and 30-day postoperative outcomes.
The 2015 to 2018 National Health and Nutrition Examination Survey cross-sectional data (N = 19,225) generated US with class II/III obesity prevalence estimates. The 2015 to 2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) longitudinal (30 days) cohort data were used to compare adolescent and adult (N = 748,622) postoperative outcomes and to calculate utilization rates.
The 2015 to 2018 youth and adult MBS utilization rates were calculated using MBSAQIP data (numerator) and National Health and Nutrition Examination Survey data (denominator). Two-sample tests of proportions were performed to compare the MBS utilization rates by age, ethnicity, and sex and expressed per 1000.
Mean age of the analytical MBSAQIP sample was 17.9 (1.15) years in youth (n = 3846) and 45.1 (11.5) in adults (N = 744,776), majority female (77.4%, 80.7%, respectively) and non-Hispanic White (68.5%, 59.4%, respectively). The overall 2015 to 2018 MBS utilization rate for youth was 1.81 per 1000 and 5.56 per 1000 for adults ( P < 0.001). Adult patients had slightly higher percentage (4.2%) of hospital readmissions compared to youth (3.4%, P = 0.01) but there were no other post-MBS complication differences. From 2015 to 2018 the US prevalence of youth with class II/III obesity increased in Hispanics and non-Hispanic Blacks (P trend < 0.001), but among youth who did complete MBS non-Hispanic Whites had higher rates of utilization (45.8%) compared to Hispanics (22.7%) and non-Hispanic blacks 14.2% (P = 0.006).
MBS is an underutilized obesity treatment tool for both youth and adults, and among ethnic minority groups in particular.
在美国儿科人群中，肥胖的 II 类（120%>体重指数 [BMI]<年龄和性别第 95 百分位的 140%）和 III 类（BMI>年龄和性别第 95 百分位的 140%）肥胖是增长最快的亚类。代谢和减肥手术（MBS）是治疗 II/III 类肥胖的安全有效治疗选择。本分析的主要目的是确定：（1）目前美国 MBS 在 II/III 类肥胖患者中的使用率；（2）使用率和 30 天术后结果。
2015 年至 2018 年全国健康和营养检查调查横断面数据（N = 19225）生成了美国 II/III 类肥胖的患病率估计值。2015 年至 2018 年代谢和减肥手术认证和质量改进计划（MBSAQIP）的纵向（30 天）队列数据用于比较青少年和成人（N = 748622）术后结果并计算使用率。
使用 MBSAQIP 数据（分子）和全国健康和营养检查调查数据（分母）计算 2015 年至 2018 年青年和成人 MBS 的使用率。使用两样本比例检验比较按年龄、族裔和性别划分的 MBS 使用率，并以每 1000 例表示。
分析性 MBSAQIP 样本的平均年龄为青少年（n = 3846）为 17.9（1.15）岁，成人（N = 744776）为 45.1（11.5）岁，多数为女性（分别为 77.4%和 80.7%）和非西班牙裔白人（分别为 68.5%和 59.4%）。2015 年至 2018 年，青少年 MBS 的总体使用率为每 1000 例 1.81 例，成人每 1000 例 5.56 例（P < 0.001）。与青少年相比，成年患者的医院再入院率略高（4.2%对 3.4%，P = 0.01），但 MBS 后无其他并发症差异。2015 年至 2018 年，美国 II/III 类肥胖青少年的患病率在西班牙裔和非西班牙裔黑人中有所增加（趋势 P < 0.001），但在接受 MBS 治疗的青少年中，非西班牙裔白人的利用率（45.8%）高于西班牙裔（22.7%）和非西班牙裔黑人（14.2%）（P = 0.006）。
MBS 是治疗青少年和成年人肥胖的一种未充分利用的治疗工具，特别是在少数族裔群体中。
