Bouchard Megan E, Tian Yao, Linton Samuel, De Boer Christopher, O'Connor Ann, Ghomrawi Hassan, Abdullah Fizan
Department of Surgery, Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Child Obes. 2022 Apr;18(3):188-196. doi: 10.1089/chi.2021.0201. Epub 2021 Oct 12.
Current reports of adolescent bariatric surgery underutilization for treating severe obesity do not comprehensively assess the extent of existing disparities. We sought to describe national trends in adolescent bariatric surgery over a 9-year period and investigate previously described ethnoracial-, insurance-, income-, and geographic-based disparities. A cross-sectional analysis of adolescents aged 10-19 years who underwent bariatric surgery from 2009 to 2017 was conducted using Healthcare Cost and Utilization Kids' Inpatient Database and National Inpatient Sample Databases. Annual rates and types of bariatric surgery were assessed using trend analysis and stratified by patient, hospital, and regional characteristics. The rate of bariatric surgeries per 1,000,000 adolescents with severe obesity increased over time (227 cases in 2009 to 331cases in 2017). Roux-en-Y gastric bypass and gastric band significantly decreased ( < 0.001), while sleeve gastrectomy became the most commonly performed bariatric surgery ( < 0.001). Surgeries were increasingly performed in urban teaching hospitals (77.9%) and most commonly in the Northeast (34.4%) and South (40.9%). The proportion of black patients (12.1%-15.8%) undergoing bariatric surgery increased, although was not significant and remained below that of white patients ( = 0.06). The proportion of publicly insured patients undergoing bariatric surgery significantly increased (17.0% to 30.7%, < 0.001), although no changes were observed based on median household income. Over the study period, utilization of adolescent bariatric surgery has increased. Yet, vulnerable populations, who have the highest rates of severe obesity, continue to undergo bariatric surgery at disproportionately lower rates. Further efforts to address disparities and barriers to care are urgently needed to care for these children.
目前关于青少年减肥手术治疗重度肥胖未得到充分利用的报告并未全面评估现有差异的程度。我们试图描述9年间青少年减肥手术的全国趋势，并调查先前描述的基于种族、保险、收入和地理的差异。使用医疗成本和利用儿童住院数据库以及全国住院样本数据库，对2009年至2017年接受减肥手术的10至19岁青少年进行了横断面分析。使用趋势分析评估减肥手术的年发生率和类型，并按患者、医院和地区特征进行分层。每百万患有重度肥胖的青少年中减肥手术的发生率随时间增加（2009年为227例，2017年为331例）。Roux-en-Y胃旁路术和胃束带术显著减少（<0.001），而袖状胃切除术成为最常进行的减肥手术（<0.001）。手术越来越多地在城市教学医院进行（77.9%），最常见于东北部（34.4%）和南部（40.9%）。接受减肥手术的黑人患者比例（12.1%-15.8%）有所增加，尽管不显著且仍低于白人患者（P=0.06）。接受减肥手术的公共保险患者比例显著增加（17.0%至30.7%，<0.001），尽管根据家庭收入中位数未观察到变化。在研究期间，青少年减肥手术的利用率有所提高。然而，重度肥胖发生率最高的弱势群体接受减肥手术的比例仍然低得多。迫切需要进一步努力解决护理方面的差异和障碍，以照顾这些儿童。
