麻豆传媒

In the years after bariatric surgery for severe obesity, teens who had opted for sleeve gastrectomy had fewer brushes with the emergency department (ED), according to an analysis of Medicaid claims data.

Over a median follow-up of 575 days, sleeve gastrectomy was associated with a significantly lower 5-year risk of ED use compared with Roux-en-Y gastric bypass (53.3% vs 59.9%; P=0.01), reported Ryan Howard, MD, MS, of the University of Michigan in Ann Arbor, and colleagues.

Furthermore, the 5-year risk of hospitalization was 36.9% with sleeve gastrectomy versus 52.1% with gastric bypass (P=0.001), they noted in a research letter published in .

However, the two surgical groups had similar 5-year risks of complications (1.5% vs 2.1%), reoperations (7.2% vs 7.7%; defined as biliary procedures and abdominal wall, internal, and paraesophageal hernia repair), and revisions (1.1% vs 0.7%; defined as any operation that directly modified the index procedure).

Of note, there was also no difference in mortality rates between the groups (0.2% with sleeve gastrectomy vs 0% with gastric bypass).

"Although Medicaid is the single largest insurer of adolescents in the U.S., the comparative outcomes (which may help inform coverage policy and decision-making) of these 2 procedures have yet to be described in this population," Howard and team wrote.

"These results may help inform the treatment of severe obesity in adolescents insured by Medicaid, although future studies should also evaluate long-term weight loss and comorbidity resolution in this population," they concluded.

Howard's group pointed out that the key takeaway here is that rates of death, complications, and reoperations were fairly low for both surgery types, which is consistent with previous studies.

For this analysis, they used national Medicaid claims data to identify adolescents with severe obesity who underwent laparoscopic sleeve gastrectomy (n=855) or Roux-en-Y gastric bypass (n=277) from January 2012 through December 2018.

"Only 1,132 patients were identified over 7 years, suggesting that this treatment is infrequently used in this population, possibly due to access issues or controversies over the use of bariatric surgery in young patients," the team noted.

From 2012 to 2018, the annual percentage of sleeve gastrectomy relative to gastric bypass increased from 48.8% to 82.6%.

In both groups, mean age was about 19 years. As consistent with a bariatric surgery cohort, 75% to 80% were female, and 44-46% were white, 33-37% were Hispanic, and 18-23% were Black.

The most common comorbidities among the groups were chronic pulmonary disease, hypertension, liver disease, depression, and diabetes.

Healthcare utilization included all-cause ED use and hospitalization, and was identified using a revenue center code algorithm.

Some limitations to the study included its small sample size and short follow-up period, Howard and team noted.

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