Trends and Outcomes of Metabolic Surgery in Adolescents with BMI ≥ 50 vs < 50 kg/m2: A Retrospective Study Using the MBSAQIP Database

Abstract

Background: Metabolic and bariatric surgery (MBS) is an effective and increasingly utilized treatment for adolescents with severe obesity, particularly those with BMI ≥ 50 kg/m2. However, data on safety and outcomes in this high-risk group remains limited. Methods: We conducted a retrospective analysis of the MBSAQIP database from 2020–2023, identifying adolescents aged 13–18 years who underwent primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Patients were stratified by BMI into < 50 kg/m2 and ≥ 50 kg/m2 cohorts. Thirty-day outcomes were compared, and multivariable logistic regression was used to identify predictors of serious complications. Results: Among 3,056 adolescents (0.4% of 692,615 total cases), 2,134 (69.8%) had BMI < 50 and 922 (30.2%) had BMI ≥ 50 kg/m2. MBS volume increased by 51% from 2020 to 2023. The BMI ≥ 50 cohort had more comorbidities: diabetes (20.9% vs 14.5%), hypertension (11.8% vs 5.2%), and sleep apnea (32.9% vs 17.9%) (all p < 0.001), and longer operative times (82.8 vs 75.5 min, p < 0.001). However, serious complication rates were comparable (1.3% vs 1.5%, p = 0.668), and no 30-day mortality was reported. RYGB (OR 2.7, 95%CI 1.21–5.94, p = 0.015) and non-insulin dependent type 2 diabetes (OR 2.3, 95% CI 1.2–4.58, p = 0.016) were the independent predictors of serious complications. Conclusions: MBS is safe in adolescents, including those with BMI ≥ 50 kg/m2, with no increased short-term risk of serious complications. These findings support broader surgical consideration in this high-risk group.