The learning curve of a pediatric bariatric surgery program: Lessons learned from the first 100 patients

Pediatric obesity continues to be an epidemic and as a result, pediatric surgical programs are developing expertise in bariatric surgery to improve outcomes in these children. This study aims to characterize the pathway from initiation to designation by The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) as a Center of Excellence over the course of our first 100 patients, and examine the implementation and associated learning curve of an institutional pediatric bariatric program at a free-standing children's hospital.

Retrospective review of prospectively collected data from the first 100 laparoscopic sleeve gastrectomy patients at a freestanding academic children's hospital. Patients were separated into quartiles to evaluate outcome measures. Demographics, perioperative and follow-up data were collected to reflect the ASMBS recommended reporting standards.

100 patients were reviewed from 2015-2022. Significant reductions were seen in average operative time (127.6 vs. 65.3 min, p < 0.001), supply cost ($9031.08 vs. $2918.92, p < 0.001), postoperative length of stay (3.2 vs. 2.0 days, p < 0.001), and postoperative narcotic usage (8.4 vs. 1.8 doses, p < 0.001), between the first and fourth quartiles. Beginning in 2019, quality improvement initiatives were developed annually.

Partnership with an established high-volume bariatric center and accumulation of experience, followed by systematic implementation of quality and safety measures through MBSAQIP, can substantially improve the care provided to adolescent patients during the building of a pediatric bariatric program.