University of Oklahoma Health Sciences Center

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Author/s:

Inge, Thomas H., Courcoulas, Anita P., Jenkins, Tod M., Michalsky, Marc P., Brandt, Mary L., Xanthakos, Stavra A., Dixon, John B., Harmon, Carroll M., Chen, Mike K., Xie, Changchun, Evans, Mary E., Helmrath, Michael A.

Date Added:

May 30, 2019

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

May 30, 2019

URL:

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

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa1813909

PMID (1):

31116917

Keywords

gastric bypass

MeSH

bariatric surgery

gastric bypass

RPR Commentary

Gastric bypass operations appear to work as well in adolescents as in adults. James W. Mold, MD, MPH

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.)

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