Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults

Abstract

Background: Bariatric surgery results in weight loss and health improvements in adults and adolescents. However, whether outcomes differ according to the age of the patient at the time of surgery is unclear.

Methods: We evaluated the health effects of Roux-en-Y gastric bypass in a cohort of adolescents (161 patients enrolled from 2006 through 2012) and a cohort of adults (396 patients enrolled from 2006 through 2009). The two cohorts were participants in two related but independent studies. Linear mixed and Poisson mixed models were used to compare outcomes with regard to weight and coexisting conditions between the cohorts 5 years after surgery. The rates of death and subsequent abdominal operations and selected micronutrient levels (up to 2 years after surgery) were also compared between the cohorts.

Results: There was no significant difference in percent weight change between adolescents (-26%; 95% confidence interval [CI], -29 to -23) and adults (-29%; 95% CI, -31 to -27) 5 years after surgery (P = 0.08). After surgery, adolescents were significantly more likely than adults to have remission of type 2 diabetes (86% vs. 53%; risk ratio, 1.27; 95% CI, 1.03 to 1.57) and of hypertension (68% vs. 41%; risk ratio, 1.51; 95% CI, 1.21 to 1.88). Three adolescents (1.9%) and seven adults (1.8%) died in the 5 years after surgery. The rate of abdominal reoperations was significantly higher among adolescents than among adults (19 vs. 10 reoperations per 500 person-years, P = 0.003). More adolescents than adults had low ferritin levels (72 of 132 patients [48%] vs. 54 of 179 patients [29%], P = 0.004).

Conclusions: Adolescents and adults who underwent gastric bypass had marked weight loss that was similar in magnitude 5 years after surgery. Adolescents had remission of diabetes and hypertension more often than adults. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases; ClinicalTrials.gov number, NCT00474318.).

Figure 1.. Weight Change and Remission of Diabetes and Hypertension during the 5-Year Period after Gastric Bypass Surgery.

Line graphs represent modeled mean percent changes in weight from baseline to 5 years for gastric bypass surgery in adult and adolescent cohorts, and dots represent observed values from individual participants (Panel A). Also shown is the modeled remission of type 2 diabetes (Panel B) and hypertension (Panel C) at each study visit during the 5 years after gastric bypass surgery in the two cohorts. I bars in all panels represent 95% confidence intervals.

Figure 2.. Adjusted Risk Ratios for Remission of Multiple Coexisting Conditions of Obesity During the 5-Year Period After Gastric Bypass Surgery.

Shown are the risk ratios, estimated from a statistical model, for remission of type 2 diabetes, hypertension, hypertriglyceridemia, and low levels of high-density lipoprotein (HDL) cholesterol among adolescent participants in the Teen–Longitudinal Assessment of Bariatric Surgery (Teen–LABS) study as compared with adults in the LABS study (with adults as the reference group). Definitions for these coexisting conditions are provided in the Supplementary Appendix. Horizontal bars represent 95% confidence intervals.