Recent National Trends in the Use of Adolescent Inpatient Bariatric Surgery 2000 Through 2009
Recent National Trends in the Use of Adolescent Inpatient Bariatric Surgery 2000 Through 2009
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DOI：
10.1001/2013.jamapediatrics.286
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发表时间：
2013-02-01
期刊：
影响因子：
26.1
通讯作者：
Burd, Randall S.
中科院分区：
文献类型：
--
作者：
Kelleher, Deirdre C.;Merrill, Chaya T.;Burd, Randall S.
目的：确定青少年中目前的住院减肥手术率，并分析2000年至2009年的全国使用趋势。设计：回顾性横断面研究。设置：从2000年至2009年的医疗保健成本和利用项目儿童住院患者数据库获得的出院数据。参与者：青少年（定义为10-19岁的个体）接受住院减肥手术。干预：住院减肥手术。主要结果测量：主要结果测量是基于全国人口的减肥手术率。次要结局指标为2000年至2009年的手术率和类型、人口统计学资料、并发症发生率、住院时间和住院费用的趋势。住院减肥手术率由2000年的每10万人0.8例上升至2003年的每10万人2.3例（328 vs 987例手术），但在2006年（2.2/100 000）或2009年（2.4/100 000）没有显著变化，分别为925 vs 1009例手术。到2009年，腹腔镜可调节胃束带的使用接近所有手术的三分之一（32.1%）。该队列主要是女性，年龄在17岁以上。合并症的患病率从2003年（49.3%）增加到2009年（58.6%）（P= 0.002），而并发症发生率仍然较低，住院时间缩短了约1天（P <0.001）。越来越多的患者有医疗补助作为他们的主要付款人来源，但是，大多数（68.3%，2009年）有私人insurance.Conclusions：尽管儿童肥胖症的流行日益恶化，青少年住院减肥手术率自2003年以来一直保持稳定。主要的手术类型已变为微创技术，包括腹腔镜可调节胃束带术和腹腔镜Roux-en-Y胃旁路术。趋势显示并发症发生率较低，住院时间缩短，尽管患者的合并症增加。JAMA Pediatr. 2013; 167（2）：126-132. 2012年12月17日在线发布。doi：10.1001/2013.jamapediatrics.286
Objectives: To determine the current rate of inpatient bariatric surgical procedures among adolescents and to analyze national trends of use from 2000 to 2009.Design: Retrospective cross-sectional study.Setting: Discharge data obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database, 2000 through 2009.Participants: Adolescents (defined herein as individuals aged 10-19 years) undergoing inpatient bariatric procedures.Intervention: Inpatient bariatric surgery.Main Outcome Measures: The primary outcome measure was the national population-based bariatric procedure rate. The secondary outcome measures were trends in procedure rates and type, demographics, complication rate, length of stay, and hospital charges from 2000 through 2009.Results: The inpatient bariatric procedure rate increased from 0.8 per 100 000 in 2000 to 2.3 per 100 000 in 2003 (328 vs 987 procedures) but did not change significantly in 2006 (2.2 per 100 000) or 2009 (2.4 per 100 000), with 925 vs 1009 procedures. The use of laparoscopic adjustable gastric banding approached one-third (32.1%) of all procedures by 2009. The cohort was predominantly female and older than 17 years. The prevalence of comorbidities increased from 2003 (49.3%) to 2009 (58.6%) (P=.002), while the complication rate remained low and the in-hospital length of stay decreased by approximately 1 day (P < .001). Increasing numbers of patients had Medicaid as their primary payer source; however, most (68.3% in 2009) had private insurance.Conclusions: Despite the worsening childhood obesity epidemic, the rate of inpatient bariatric procedures among adolescents has plateaued since 2003. The predominant procedure type has changed to minimally invasive techniques, including laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Trends show low complication rates and decreasing length of stay, despite increasing comorbid conditions among patients. JAMA Pediatr. 2013; 167(2): 126-132. Published online December 17, 2012. doi: 10.1001/2013.jamapediatrics.286