Incidence and Predictors of Textbook Outcomes after Metabolic and Bariatric Surgery in Adolescents

Background: Textbook outcomes (TO) are an increasingly adopted composite quality metric in surgery; incidence and determinants in adolescent metabolic and bariatric surgery have not been defined. We evaluated procedure-specific TO rates and factors associated with achieving TO after vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB). Study Design: Retrospective cohort study of 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. Results: Overall, 90.8% of patients achieved TO, with higher rates after VSG than RYGB (91.7% vs 85.7%; p<0.001). RYGB was associated with higher rates of prolonged length of stay (9.6% vs 6.3%), readmission (5.1% vs 2.2%), and major complications (0.9% vs 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). Minority race/ethnicity was independently associated with lower odds of TO for both procedures. TO rates improved over time (p<0.001). Conclusions: TO is achieved in approximately nine of ten adolescents undergoing metabolic and bariatric surgery and is more common after VSG than RYGB. Prolonged length of stay is the principal contributor to TO failure, while procedure type, operative approach, patient age, operative year, and race/ethnicity are associated with TO achievement.