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Bariatric Surgery for Adolescents and Young Adults: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Evidence-Based Guidelines

Last updated: August 3, 2016
Project Number: RC0797-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative clinical effectiveness of bariatric surgery versus alternative surgical procedures or non-surgical treatments for obese patients with a mean age of 18 years or younger?
  2. What is the cost-effectiveness of bariatric surgery for obese patients with a mean age of 18 years or younger?
  3. What are the evidence-based guidelines regarding bariatric surgeries for obese patients with a mean age of 18 years or younger?

Key Message

Five systematic reviews, two economic evaluations, two reviews of guidelines, and six primary evidence-based guidelines were identified regarding the clinical and cost-effectiveness, and guidelines for the use of bariatric surgery in adolescents and young adults. Very few comparative clinical studies have been conducted in the area of adolescent bariatric surgery. The limited available evidence suggests superior weight loss, and resolution of comorbidities compared to non-surgical interventions, and potential superior weight loss with Roux-en-Y gastric bypass versus other procedures. Complications are common, and the effect of surgery on outcomes such as quality of life, psychosocial outcomes, long-term weight loss and complications, and mortality remain uncertain. Cost-effectiveness data is lacking, but limited evidence suggests that bariatric surgery is cost-effective several years after intervention, but not immediately. Evidence-based guidelines reflect the limited evidence-base in the low strength of their recommendations. Most guidelines suggest that under specific circumstances, bariatric surgery may be indicated for adolescent patients, but that patients must meet a strict clinical and psychiatric profile, and that the procedure requires substantial support from a multidisciplinary team with pediatric expertise, and sufficient community and family involvement.