Bariatric surgery practice patterns among pediatric surgeons in the United States

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Abstract

Background

Metabolic and bariatric surgery (MBS) in adolescents has been shown to be safe and effective, but current practice patterns are variable and poorly understood. The aim of this study is to assess current MBS practice patterns among pediatric surgeons in the United States.

Methods

American Pediatric Surgical Association members were surveyed on current bariatric surgery practices.

Results

Four hundred and three (40%) surgeons out of a total of 1013 pediatric surgeons responded to the survey. Only 2 respondents had additional training in MBS (0.5%). One hundred thirty-two (32.6%) report that their practice participates in metabolic and bariatric surgery, with 123 (30.4%) having a specific partner specializing in MBS. Most respondents (92%) stated that they believe high volume is associated with better outcomes with regard to MBS. Only 17 (4.2%) surgeons performed a metabolic and bariatric surgery in the last year. All routinely perform sleeve gastrectomy as their primary procedure. Most (82%) perform procedures with an additional surgeon, either another pediatric surgeon (47%) or an adult bariatric surgeon (47%). All pediatric bariatric surgeons responded that they believe high volume led to better outcomes. Adolescent MBS programs most commonly included pediatric nutritionists (94%), pediatric psychologists (94%), clinical nurses (71%), clinical coordinators (59%), pediatric endocrinologists (59%), and exercise physiologists (52%).

Conclusion

Only 17 (4.2%) respondents had performed a metabolic and bariatric surgery in the past year, and few of those had additional training in MBS. Future work is necessary to better understand optimal practice patterns for adolescent metabolic and bariatric surgery.

Type of study

Review article.

Level of evidence

Level III.

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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