Most Adolescents Undergoing Bariatric Surgery Experience Textbook Outcomes

Olson MT, Shacker M, Chinn JO, Laton BD, Pratt JSA. Incidence and Predictors of Textbook Outcomes after Metabolic and Bariatric Surgery in Adolescents. J Am Coll Surg. July 2026.

Textbook outcomes (TO) are an increasingly adopted composite quality metric in surgery, but their incidence and determinants in adolescent metabolic and bariatric surgery have not been defined. Olson et al evaluated procedure-specific TO rates and factors associated with achieving TO after vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB).

This retrospective cohort study analyzed data from adolescents aged 10 to <20 years undergoing primary laparoscopic or robotic-assisted VSG or RYGB in the MBSAQIP database (2015–2024). TO was defined as the absence of intraoperative or postoperative adverse events, prolonged length of stay (>2 days), major complications, 30-day readmission, reoperation, or mortality. Multivariable logistic regression identified procedure-specific predictors of TO.

Overall, 90.8% of patients achieved TO, with higher rates after VSG than RYGB (91.7% compared with 85.7%; p<0.001). RYGB was associated with higher rates of prolonged length of stay (9.6% compared with 6.3%), readmission (5.1% compared with 2.2%), and major complications (0.9% compared with 0.5%) (all p≤0.03). 

For VSG, robotic-assisted surgery (aOR 1.84, 95% CI 1.39–2.48), increasing age (aOR 1.12, 95% CI 1.06–1.18), and later operative year (aOR 1.10, 95% CI 1.07–1.14) independently predicted TO, whereas only later operative year predicted TO after RYGB (aOR 1.10, 95% CI 1.04–1.17). Racial/ethnic minority status was independently associated with lower odds of TO for both procedures. TO rates improved over time (p<0.001).

TO was achieved in approximately nine of 10 adolescents undergoing metabolic and bariatric surgery and was more common after VSG than RYGB. Prolonged length of stay was the principal contributor to TO failure, while procedure type, operative approach, patient age, operative year, and race/ethnicity were associated with TO achievement.