Beyond surgery: a multimodal framework for a pediatric metabolic and bariatric surgery program in a safety-net...

Area of Science:

• Pediatric Surgery
• Public Health
• Healthcare Management

Background:

• Severe pediatric obesity disproportionately impacts low-income and publicly insured youth.
• Access to metabolic and bariatric surgery (MBS) is limited for these populations despite guidelines.
• Safety-net hospitals face unique challenges in providing specialized care.

Purpose of the Study:

• To describe the development of a pediatric MBS program within a safety-net children's hospital.
• To outline a structured framework emphasizing interdisciplinary collaboration and equitable access.
• To address barriers hindering surgical care for youth with severe obesity.

Main Methods:

• Utilized real-world clinical vignettes to identify barriers like delayed care and medical complexity.
• Implemented an integrated, adaptive approach involving multidisciplinary teams and ethical review.
• Incorporated pre- and post-operative antiobesity medication and advocated for financial sustainability.

Main Results:

• The developed model demonstrated improved access for historically excluded populations.
• The program supports safe and effective surgical care for pediatric patients with severe obesity.
• Early outcomes indicate the program's potential to reduce disparities in surgical access.

Conclusions:

• The described framework can guide other institutions, including those with diverse payor mixes, in implementing pediatric MBS.
• This model is particularly relevant for resource-limited or safety-net settings.
• The approach promotes equitable access to essential surgical interventions for youth with severe obesity.