O3033: An Update on Outcomes After Sleeve Gastrectomy in Children with Special Needs: Implications for the AAP Clinical Practice Guidelines

Background: The American Academy of Pediatrics (AAP) recently released clinical guidelines for the treatment of childhood obesity, including surgery being appropriate for ALL children 13 years of age and older. The section addressing children with special health care needs (CYSHCN) recommends “that management of obesity for CYSHCN includes similar protocols and processes as those for children with typical development” but provides no data on surgery outcomes. We previously published CYSHCN are as successful after laparoscopic sleeve gastrectomy (LSG) as children with typical neurocognitive development (TND). However, little else has been published on the topic and it remains unclear whether CYSHCN should have different eligibility criteria for bariatric surgery. Thus, we reviewed our experience with LSG to treat obesity in CYSHCN since our previous publication to further explore outcomes in CYSHCN compared to those in children with TND.

Methods: Patients who underwent mental health evaluation to assess readiness for bariatric surgery at our single center from 2018-present were reviewed for the presence of cognitive impairment or developmental differences (CYSHCN). Patients’ self-reported disorders were abstracted and categorized as: 1) Autism Spectrum Disorder (ASD); 2) Prader-Willi Syndrome (PWS); 3) Trisomy 21 (T21); or 4) Intellectual Development Disability (IDD). Demographics and weight loss outcomes were obtained. Outcomes for CYSHCN were compared to outcomes for the TND group, and then compared among the individual diagnoses identified.

Results: A total of 493 patients underwent laparoscopic sleeve gastrectomy at our institution since 2018 of whom 34 were identified as CYSHCN. There were 16 patients with ASD, 13 with IDD, 4 with T21, and 1 with PWS. The CYSHCN group had an average age of 17±3, weighed 142±36 kg, had a BMI of 52±11, were 50% female, 60% Black and 20% Hispanic. None of these demographics differed from the TND group, although percent female trended toward significance (50% v 66%, p< 0.1). For CHYSCN, decrease in BMI was 12±4 at 6-months and 15±9 at 12-months after surgery. Percent excess weight loss (%EWL) was 41±15 at 6-months and 46±23 at 12-months, and percent excess BMI loss was 49±22 at 6-months and 53±25 kg/m2 at 12-months after surgery. Only %EWL at 9-months differed between the 2 groups (40±17 v 50±17, p=0.04), with CYSHCN demonstrating lower %EWL (Table 1). Comparing the ASD and IDD groups, ASD patients were less likely to be female (31% v 77%, p=0.03), and had greater %EWL at 6-months (50±11 v 36±13, p=0.03).(Table 2)

Conclusion: This study demonstrates that LSG for CYSHCN with severe obesity is efficacious when performed at specialized centers, and unique qualification criteria are not required for these children. We encourage the AAP and others to continue to include CYSHCN when creating guidelines for the treatment of obesity with bariatric surgery, and include the data supporting its use.