One-year Weight Loss and Metabolic Outcomes after Laparoscopic Sleeve Gastrectomy in Adolescents Compared with Young Adults: A Propensity Score-Matched Cohort Study

Introduction:Adolescent bariatric surgery is rising, but comparative outcome data for sleeve gastrectomy in adolescents and young adults remain limited. Pre-surgical glucagon-like peptide-1 receptor agonist use in younger patients represents an unaddressed confounder. We therefor compared 1-year weight loss, metabolic comorbidity, nutritional and surgical outcomes of laparoscopic SG between adolescents (13-17 years) and young adults (18-21years) with severe obesity, using propensity score matching (PSM). Methods:This retrospective comparative cohort study used the TriNetX US Collaborative Network,a fedrated electronic health record platform spanning 66 health care organizations and approximately 113 million patients. Patients who underwent laparoscopic SG with morbid obesity were identified and stratified by age group. After exclusion of prior or concurrent alternative bariatric procedures, adolescents (n = 327) and young adults (n = 1056) were matched 1:1 using 25 pre-surgical characteristics, including GLP-1 RA medications. Outcomes were assessed at 1 year. Results:After PSM, 318 matched pairs were analyzed. Pre-surgical semaglutide use was markedly higher among adolescents (29.4% vs 14.6%; SMD 0.363 before matching) and was balanced after matching (27.4% vs 26.1%; SMD 0.028). At 1-year, post-operative Body Mass Index (BMI) was equivalent (38.6 ± 8.7 vs 39.1 ± 8.8 kg/m2; p = 0.534). No significant differences were observed in type 2 diabetes persistence, hypertension persistence, dyslipidemia, NAFLD, or new-onset GERD. No reoperations or conversions to RYGB occurred at 1 year. Approximately 49% of patients in both cohorts had pre-existing vitamin D insufficiency. Sex-stratified analyses were concordant with primary findings. Conclusions:Adolescents achieve equivalent 1-year weight loss and metabolic outcomes following SG compared with young adults. Pre-surgical GLP-1 RA exposure is substantially higher in adolescents and must be controlled for in comparative bariatric research. The high prevalence of pre-existing vitamin D insufficiency in this population warrants routine pre-operative assessment and supplementation.