Metabolic and bariatric surgery in adolescents compared to young adults: an MBSAQIP database analysis

Metabolic and bariatric surgery (MBS) is a highly durable, safe and effective treatment for severe obesity in adults. However, MBS remains underutilized in the pediatric and adolescent population, likely due to safety concerns of elective surgery in children.

We aimed to analyze whether the benefits of MBS outweigh the risks in adolescents when compared to young adults.

Multicenter, national database study.

Patients aged 10-39 who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Patients with prior foregut surgery were excluded.

556,628 patients were identified; 10,883 (2.0%) were aged 10-19 (adolescents), 161,938 (29.1%) were 20-29 (young adults), and 383,807 (69.0%) were 30-39 (adults). Preoperative body mass index (BMI) was clinically similar between groups, though statistically significant due to large sample size (10-19: 46, 20-29: 45, 30-39: 45 kg/m², P < .001). SG was more common in younger cohorts (10-19: 86%, 20-29: 77%, 30-39: 75%, P < .001). At 30 days postoperatively, adolescents demonstrated marginally greater BMI reduction (10-19: 2.91, 20-29: 2.69, 30-39: 2.53 kg/m², P < .001). Adolescents had fewer postoperative complications, including surgical site infections, gastrointestinal bleeding, and blood transfusions (P < .001). Among adolescents, SG (aOR: .39, CI: .31-.48, P < .001) was associated with reduced postoperative complications.

Adolescents undergoing MBS have BMI reductions similar to those of young adults and have lower rates of complications and readmissions. MBS should be offered as a safe treatment for adolescents to treat morbid obesity with at least similar frequency as it is offered to adults.