Comparative effectiveness of bariatric procedures among adolescents: the PCORnet bariatric study

Background: Bariatric surgery has been used for treatment of severe obesity in adolescents but most studies have been small and limited in follow-up. Objectives: We hypothesized that electronic health record data could be used to compare effectiveness of bariatric procedures in adolescents. Setting: Data were obtained from clinical research networks using a common data model to extract data from each site. Methods: Adolescents who underwent a primary bariatric procedure from 2005 through 2015 were identified. The percent change in body mass index (BMI) at 1, 3, and 5 years was estimated using random effects linear regression for patients undergoing all operations. Propensity score adjusted estimates and 95% confidence intervals were estimated for procedures with >25 patients at each time period. Results: This cohort of 544 adolescents was predominantly female (79%) and White (66%), with mean (standard deviation) age of 17.3 (+/- 1.6) years and mean BMI of 49.8 (+/- 7.8) kg/m(2). Procedures included Roux-en-Y gastric bypass (RYGB; n = 177), sleeve gastrectomy (SG; n = 306), and laparoscopic adjustable gastric banding (n = 61). For those undergoing RYGB, SG, and laparoscopic adjustable gastric banding, mean (95% confidence interval) BMI changes of 31% (-30% to -33%), 28% (-27% to -29%), and 10% (-8% to -12%), were estimated at 1 year. For RYGB and SG, BMI changes of 29% (-26% to -33%) and 25% (-22% to -28%) were estimated at 3 years. Conclusions: Adolescents undergoing SG and RYGB experienced greater declines in BMI at 1-and 3-year follow-up time points, while laparoscopic adjustable gastric banding was significantly less effective for BMI reduction. (Surg Obes Relat Dis 2018;14:13741388.) (C) 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license.