• Surgical Weight Loss Program for Teens − Quality Measures

    Cincinnati Children’s has the most comprehensive surgical weight loss program in the nation exclusively for adolescents. Team members in this first-of-its-kind program understand the unique needs and significant impact that excess weight can have on the life of a teen.  

    Under the leadership of Thomas Inge, MD, and Stavra Xanthakos, MD, the Surgical Weight Loss Program for Teens (SWLPT) consists of professionals who are experts in their fields − surgery, pediatrics, nursing, nutrition, liver / stomach / intestinal conditions, and behavioral health.  We also provide direct access to experts in other subspecialty fields. Our team works together to provide patients and their families with high-quality, innovative medical and surgical care.

    Realizing that weight loss surgery is a difficult and life-changing decision, the surgical weight loss team provides patients with extensive, individualized assessments and preoperative treatment recommendations, directed with long-term success and safety in mind.

    Since 2001, SWLPT has offered the laparoscopic Roux-en-Y gastric bypass (RYGB).  In 2008 we began offering the laparoscopic vertical sleeve gastrectomy (VSG).  Over time, there has been a shift in procedure choice, with an increase in patients choosing the VSG over RYGB.  Our program continues to offer both RYGB and VSG.  We believe surgical choice is important.

    In collaboration with patients and families, we work together to determine the best procedure on a case-by-case basis. Tracking our patient outcomes and sharing this information creates an open environment where best practices and productive interaction among clinicians will continue to improve the care for all adolescents undergoing weight loss surgery.

  • Our Performance

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    The Surgical Weight Loss Program for Teen’s main goal is to help adolescents and their families adopt the behavioral and lifestyle changes that are needed for lifelong, successful weight management.

    For both gastric bypass and the sleeve procedure, weight regain is possible. The charts below illustrate weight loss over time for our patients who have had weight loss surgery. It is important to remember that weight loss is individualized, meaning not everyone will have the same results.

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    How Much Weight Can I Expect to Lose?

    • To see how your weight could change over time after bariatric surgery at each six-month follow-up appointment, open this interactive weight loss calculator
    • This calculator uses the performance of all SWLPT patients who have had weight loss surgery. It is an individualized prediction report and is based on your specific situation (male or female, pre-surgery weight).

    How We Measure

    These data include all the patients who have had a follow-up visit of 18 months or more. We use this period so that enough time has passed following surgery to determine whether a healthy weight is able to be maintained.

    • The lower your body mass index at the time of surgery, the more likely you will achieve an average weight.
    • Early intervention is key to optimal weight loss.  If you have concerns, talk to your healthcare professional about treatment options and a possible referral.
    • Weight loss surgery is only a tool to achieve significant weight loss; it is important that patients follow nutrition and exercise recommendations for ultimate success.

    What Other Health Results Can I Expect?

    Obesity threatens the health and welfare of millions of children and adolescents, particularly the estimated 4 percent to 7 percent of youth who are considered severely obese. For some patients, committing to a strict regimen of diet and exercise can be successful in losing weight and resolving weight-related health problems. For others, the severity of multiple health conditions makes losing weight a critical concern.  The increase in severe obesity-related health problems in adolescents, coupled with the present ineffectiveness of nonsurgical treatment, has resulted in increased acceptance of weight loss surgery as a treatment option.  Our team works in combination with patients’ primary and specialty care providers, such as endocrinology and cardiology, to monitor health conditions after weight loss surgery. 

    SWLPT patient health condition improvements 12 months after weight loss surgery: 

    • 100 percent of patients with type 2 diabetes have had resolution of their diabetes after surgery.
    • 41 percent of patients with high blood pressure have normal blood pressure or no longer need medicine.
    • 55 percent of patients with abnormal cholesterol levels now have normal or greatly improved cholesterol levels. 

    How We Measure

    Patient status on key outcomes is reviewed at 12-month follow-up appointments after surgery.

    How Risky Is Surgery?

    The Surgical Weight Loss Program for Teens team collects and analyzes our own results. Safety and reduction of risks associated with weight loss surgery are priorities.  In the section below, we describe the complications and other adverse events or risks of treatment that can result from weight loss surgery. We monitor and analyze our complications to continually improve the care we deliver and empower families to ask questions and feel comfortable with the life-changing treatment decisions they are making.

    The average hospital stay for adolescents undergoing weight loss surgery is two to three days, and most patients will return to school or work within two weeks. However, as with any major surgery, both the RYGB and VSG procedures pose potential health risks in the short and long term. 

    Risks associated with weight loss surgery can include:

    Leak of stomach contentsBowel obstruction
    Bleeding Gallstones 
    Infection Hernias
    Adverse reactions to anesthesia Low blood sugar (hypoglycemia)
    Blood clotsMalnutrition

    Lung or breathing problems 

    Stomach perforation
    Ulcer Ulcers
    Dehydration Vomiting 
    Vitamin deficiencies Death (rare)

    outcomes-bariatric-complications-combined

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    How We Measure

    These data include the outcomes of patients at six weeks following weight loss surgery.   

    Continuous Improvement

    • To decrease the amount of nausea and vomiting after sleeve gastrectomy we now apply the scopolamine patch (anti-nausea medicine) before going into the operating room.
    • We worked with the hematology team to adjust the dose of Lovenox to decrease risk of bleeding while still protecting against deep vein thrombosis (blood clots).  

    Emergency Department Visits Following Weight Loss Surgery

    The charts below account for our program’s weight loss surgeries to date, and demonstrate the percentage of patients who visited the Emergency Department to address a health issue following his/her weight loss surgery.  With each visit to the Emergency Department, the surgical weight loss team reviews the specifics of each patient event and develops a plan to decrease the likelihood of a reoccurrence.

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    outcomes-bariatric-er-vsg

    How We Measure

    These data include the outcomes of patients at six weeks following weight loss surgery. 

    Continuous Improvement

    To ensure easy access to the team for problem solving and support post-surgery, we provide all patients and families with 24-hour access to the nurse practitioner by text or phone, in addition to daily calls for the first two weeks after surgery. We have found this to be a great way to stay connected and deliver ongoing education about what to expect during this critical time. Through this process, patients are able to ask questions and discuss any concerns with the team member, which can in turn help to avoid emergency room visits.

    Nutritional care is an essential part of the long-term health of all weight loss surgery patients.  Due to the reduction in overall food intake and absorption changes of some nutrients, vitamin deficiencies may occur in weight loss surgery patients regardless of procedure type.  All SWLPT post-operative patients are carefully counseled and prescribed vitamin supplements. Laboratory testing is done at follow-up appointments to make sure vitamins are at healthy levels.

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    How We Measure

    These data include all patients who have had a follow-up visit at least 18 months following weight loss surgery.  We use this period so that enough time has passed following surgery to evaluate vitamin levels.

    Continuous Improvement

    • We begin supplementation with 5000 IU of vitamin D3 during the three to six months of medically supervised weight loss to treat pre-existing vitamin D deficiencies.
    • We increased the dosage of vitamin D3 used to treat deficiency to 50,000 IU weekly for three months.
    • We initiated an annual injection of vitamin B12 at 3000 mcg.
    • All females receive consultation with gynecology before and after surgery to assist with managing heavy menstrual bleeding and prevention of iron deficiency.
    • Female patients are offered the insertion of the Mirena IUD at the time of surgery.