Bariatric surgery practice patterns among pediatric surgeons in the United States
Introduction
Metabolic and bariatric surgery (MBS) is being performed with increasing frequency in the adolescent age group. The vertical sleeve gastrectomy (VSG) is the most commonly performed weight loss surgery in this population [1]. According to the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBASQIP), adolescent weight loss surgery can be performed at either an Adolescent Center, or more commonly, an Adult Comprehensive Center with Adolescent Qualifications [2]. When pediatric surgeons in the United States were surveyed in 2018, 52% of respondents felt that MBS is a necessary subspecialty, but only 2% reported specializing in pediatric metabolic and bariatric surgery [3]. A similar study in Europe found 13.6% of pediatric surgeons performed weight loss surgeries [4].
It has been demonstrated that improved outcomes are associated with increased patient volumes and increased specialty training in pediatrics [5], [6], [7], [8], [9]. Given the growing prevalence of pediatric obesity, it is concerning that there are few dedicated pediatric metabolic and bariatric surgeons in the United States. To better address this issue, we must first more precisely define the problem. The purpose of this study was to explore the practice patterns of pediatric metabolic and bariatric surgeons in the United States and to study inter-surgeon referral patterns of adolescents with obesity who seek MBS should they present to a pediatric surgeon who does not perform weight loss surgery.
Section snippets
Methods
After obtaining Institutional Review Board exemption at Northwell Health (IRB #20-0740), an anonymous survey (Supplement 1) was developed by the American Academy of Pediatrics (AAP) Section on Surgery Delivery of Surgical Care Committee and was distributed to American Pediatric Surgical Association (APSA) membership in October 2020 in a fashion previously described [10]. The survey was created in order to better understand the prevalence, practicality, and potential benefits of
Entire cohort
Four hundred and three (40%) out of a total of 1013 pediatric surgeons responded to the survey. Overall respondent demographics are seen in Table 1. The majority of respondents are male (72%) with a median graduation year of 2007 from pediatric surgery fellowship. Most are trained in pediatric surgery (99.0%) and work in an academic/university setting (79%). Only 2 completed additional training in metabolic and bariatric surgery (0.5%).
Pediatric metabolic and bariatric surgery
One hundred thirty-two (32.6%) respondents report that
Discussion
Despite the increasing prevalence of overweight and obesity in adolescents in the United States, there is a paucity of pediatric metabolic and bariatric surgeons to address the rising need for weight loss surgery in this age group. This problem was previously demonstrated by Rich et al. in 2018, who found that of the APSA members who responded to their survey, pediatric bariatric surgeons comprised about 2% of all survey respondents [3]. A recent survey by Roebroek et al. revealed a similar
Conclusion
The majority of pediatric surgeons surveyed referred patients with obesity to another surgeon for MBS. Only 17 (4.2%) pediatric surgeons who responded to the survey had performed a metabolic and bariatric surgery within the past year, and few of those had training in MBS, with only a minority living in southern United States where obesity rates are highest. More pediatric metabolic and bariatric surgeons are needed to treat the increasing number of adolescents with severe obesity and their
Source of funding
None.
Declaration of Competing Interest
None.
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The Role of Endoscopy in the Management of Adolescent Bariatric Patients: A Primer For Pediatric Gastroenterologists
2023, Current Gastroenterology Reports