Highlights
Early post-operative complications (within 30 days) serve as a significant predictor for increased healthcare utilization over the subsequent five years.
Unrelated healthcare utilization events occurred more frequently than those directly related to the surgical procedure, highlighting the complex medical needs of this population.
Higher baseline Body Mass Index (BMI) and the presence of hypertension at the time of surgery are associated with a higher likelihood of hospital admission during the follow-up period.
In patients without baseline type 2 diabetes, vertical sleeve gastrectomy was associated with higher rates of unrelated healthcare utilization compared to Roux-en-Y gastric bypass.
Background: The Landscape of Adolescent Severe Obesity
The prevalence of severe obesity among adolescents has risen dramatically over the last few decades, leading to an earlier onset of chronic conditions once reserved for adulthood, such as type 2 diabetes, non-alcoholic fatty liver disease, and obstructive sleep apnea. Metabolic and bariatric surgery (MBS) has emerged as the most effective intervention for achieving significant and sustained weight loss and comorbidity remission in this age group. However, while the short-term safety and efficacy of MBS in adolescents are well-documented, the long-term impact on healthcare systems—specifically how these patients utilize medical services in the years following surgery—remains a critical area of investigation.
Understanding healthcare utilization is essential for several reasons. First, it provides a realistic picture of the ‘total cost of care’ and the clinical burden associated with post-surgical management. Second, it allows clinicians to identify which patients are at the highest risk for readmissions or complications, enabling more personalized follow-up care. The Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study was designed to address these gaps by prospectively following a cohort of adolescents undergoing MBS at specialized centers.
Study Design: The Teen-LABS Cohort
The Teen-LABS study is a multicenter, prospective observational study that enrolled 228 adolescents prior to undergoing either Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG). The study was conducted across five major U.S. children’s hospitals, providing a robust and geographically diverse data set. The mean age of participants at the time of surgery was 17 years, with a mean baseline BMI of 53 kg/m2, representing a population with severe obesity and significant metabolic risk.
The primary objective of this specific analysis was to document healthcare utilization events over a five-year post-operative period. These events were meticulously categorized as either ‘related’ (e.g., surgical revisions, nutritional deficiencies, or gastrointestinal issues stemming directly from the MBS) or ‘unrelated’ (e.g., psychiatric care, orthopedic issues, or acute infections) to the bariatric intervention. Researchers utilized negative binomial regression modeling to evaluate factors that might predict the frequency and severity of these utilization events.
Key Findings: Quantifying the Healthcare Burden
The study found that healthcare utilization events are common among adolescents in the five years following MBS. Specifically, related healthcare utilization events occurred in 81 participants, totaling 141 events. This corresponds to a rate of 67.3 events per 500 person-years. In contrast, unrelated healthcare events were even more frequent, with 224 events occurring in 112 individuals, representing a rate of 107.4 per 500 person-years.
One of the most striking findings was the role of early complications. Participants who experienced a healthcare utilization event within the first 30 days post-surgery—often considered the acute recovery phase—had significantly higher rates of subsequent utilization throughout the entire five-year window. This suggests that the initial surgical outcome may set the trajectory for a patient’s long-term medical journey.
Regarding the type of surgery, the study noted that for related events or those requiring hospital admission, there was no significant difference between RYGB and VSG. However, a nuanced finding emerged among participants who did not have type 2 diabetes at baseline: those who underwent VSG actually had higher rates of unrelated healthcare utilization compared to those who received RYGB. This finding warrants further investigation into the physiological or behavioral differences between these two patient subgroups.
Factors Associated with Hospitalization
Hospital admissions accounted for 52% of all recorded healthcare utilization events. While the type of surgical procedure did not significantly influence admission rates, baseline health status did. Higher baseline BMI and the presence of hypertension were independent predictors of higher admission rates. This reinforces the clinical intuition that patients starting their surgical journey with a higher burden of disease may require more intensive resources post-operatively, even if the surgery itself is successful in inducing weight loss.
The ‘unrelated’ events also provide a window into the broader health challenges faced by this population. While the study focused on quantifying these events, the high rate of unrelated utilization suggests that bariatric surgery, while a powerful tool for weight management, does not exist in a vacuum. These patients continue to require comprehensive care for a variety of health issues that may be influenced by their history of severe obesity but are not directly caused by the surgery itself.
Expert Commentary: Clinical Implications
The Teen-LABS data provide a crucial ‘real-world’ perspective that should be integrated into the informed consent process. When counseling adolescent candidates and their families, surgeons and pediatricians can now provide more concrete expectations regarding the likelihood of future medical visits and hospitalizations. The finding that 30-day complications predict long-term utilization is particularly actionable; it suggests that patients who struggle early on should be flagged for more frequent monitoring and perhaps more aggressive multidisciplinary support.
Furthermore, the high rate of unrelated events underscores the necessity of the ‘medical home’ model. Adolescents undergoing MBS should not be managed solely by a surgical team but should remain closely integrated with primary care, psychology, and nutrition services. The transition from pediatric to adult care is a particularly vulnerable time for this cohort, and the clinical burden identified in this study emphasizes the need for a seamless handoff between health systems.
Summary and Future Directions
In conclusion, while metabolic and bariatric surgery is a life-altering and often life-saving intervention for adolescents with severe obesity, it is associated with a significant level of ongoing healthcare utilization. The Teen-LABS study highlights that early post-operative events are strong indicators of future clinical needs. Moreover, the baseline severity of obesity and hypertension continues to influence a patient’s medical trajectory for years after the procedure.
Future research should focus on the qualitative nature of these utilization events—particularly the unrelated ones—to determine if targeted interventions (such as enhanced mental health support or specialized musculoskeletal care) could reduce the overall burden on both the patient and the healthcare system. As VSG remains the most common procedure performed globally, understanding why it was associated with higher unrelated events in certain subgroups will also be vital for refining patient selection and surgical decision-making.
Funding and Clinical Trials
National Institutes for Health (NIH) research support was provided through the following grants: NIH UM1DK072493 and NIH UM1DK095710. The contents of this manuscript are the authors’ sole responsibility and do not necessarily represent official NIH views. Relevant clinical trial identifiers related to the Teen-LABS consortium include NCT00474318.
References
1. Beamish AJ, Jenkins T, Ryder JR, et al. Healthcare utilisation across five years among adolescents following metabolic-bariatric surgery; a prospective observational study. Lancet Reg Health Am. 2025;54:101332. doi:10.1016/j.lana.2025.101332.
2. Inge TH, Courcoulas AP, Jenkins TM, et al. Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults. N Engl J Med. 2019;380(22):2136-2145. doi:10.1056/NEJMoa1813909.
3. Michalsky M, Reichard K, Inge T, et al. Adolescent LGBP and SG: Design of the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. Surg Obes Relat Dis. 2011;7(5):609-617.
