Factors Associated With Complications and Increased Length of Stay After Bariatric Surgery in Pediatric Patients

Roughly one in five adolescents have obesity in the United States. As this population continues to grow, metabolic and bariatric surgery (MBS) may provide a definitive long-term weight loss solution. We aim to describe the current trends of pediatric metabolic and bariatric surgery and identify factors associated with length of stay and postoperative complications.

Data were acquired from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database from 2013 to 2021. Patients who underwent Roux-en-Y gastric bypass, gastric banding, sleeve gastrectomy (SG), or another bariatric procedure were included. Patients with a body mass index (BMI) < 30 kg/m² were excluded. Descriptive statistics analyzed utilization trends and baseline characteristics, while univariable and multivariable regressions analyzed associations of patient-level factors with length of stay and major 30-d postoperative complications.

Of 629 patients identified, 27 were excluded due to having a BMI < 30 kg/m². The mean age was 16.2 ± 1.5 y and ranged between 9 and 18. Between 2013 and 2015, 79.4% of procedures were Roux-en-Y gastric bypass, while 91.7% were SG between 2016 and 2021. SG was significantly associated with decreased length of stay (β = -0.78, P = 0.001), while longer operative time (β = 0.004, P = 0.04), esophageal/gastric/intestinal disease (β = 0.51, P = 0.018), and steroid use (β = 4.29, P < 0.001) were associated with longer hospital stays. Only ventilator dependence (odds ratio = 4.67, P = 0.002) was associated with suffering a major complication on multivariable regression.

Factors associated with longer hospital stays, particularly preoperative steroid use, highlight the need for targeted preoperative optimization and appropriate patient selection to improve postoperative recovery. Further research is warranted to explore the long-term implications of SG utilization.