Impact of Racial Disparities in Preoperative Cardiovascular Evaluation and Surgical Outcomes in Patients Undergoing Metabolic and Bariatric Surgery: A Retrospective Cohort Analysis

Abstract

Background We investigated preoperative referral patterns, rates of cardiovascular testing, surgical wait times, and postoperative outcomes in White versus Black, Hispanic, or other racial or ethnic groups of patients undergoing metabolic and bariatric surgery. Methods and Results This was a single center retrospective cohort analysis of 797 consecutive patients undergoing metabolic and bariatric surgery from January 2014 to December 2018; 86% (n=682) were Black, Hispanic, or other racial or ethnic groups. White versus Black, Hispanic, or other racial or ethnic groups had similar baseline comorbidities and were referred for preoperative cardiovascular evaluation in similar proportion (65% versus 68%, P =0.529). Black, Hispanic, or other racial or ethnic groups of patients were less likely to undergo preoperative cardiovascular testing (unadjusted odds ratio [OR], 0.56; 95% CI, 0.33–0.95; P =0.031; adjusted for Revised Cardiac Risk Index OR, 0.59; 95% CI, 0.35–0.996; P =0.049). White patients had a shorter wait time for surgery (unadjusted hazard ratio [HR], 0.7; 95% CI, 0.58–0.87; P =0.001; adjusted HR, 0.7; 95% CI, 0.56–0.95; P =0.018). Reduction in body mass index at 6 months was greater in White patients (12.9 kg/m 2 versus 12.0 kg/m 2 , P =0.0289), but equivalent at 1 year (14.9 kg/m 2 versus 14.3 kg/m 2 , P =0.330). Conclusions White versus Black, Hispanic, or other racial or ethnic groups of patients were referred for preoperative cardiovascular evaluation in similar proportion. White patients underwent more preoperative cardiac testing yet had a shorter wait time for surgery. Early weight loss was greater in White patients, but equivalent between groups at 12 months.

Closing the gap: Perioperative health care disparities and patient safety interventions

“…One study reported differences in cardiovascular assessment before bariatric surgery after adjusting for baseline cardiovascular risk, with white patients receiving more extensive cardiovascular testing than non-white patients. 7 Furthermore, white patients received more stress testing and shorter wait times for surgery than non-white patients even after adjusting for markers of socioeconomic status, including insurance provider and income. 7 Advance care planning Advance care planning as part of the consent process and preprocedural readiness ensures patient care is aligned with their goals.…”

“…7 Furthermore, white patients received more stress testing and shorter wait times for surgery than non-white patients even after adjusting for markers of socioeconomic status, including insurance provider and income. 7 Advance care planning Advance care planning as part of the consent process and preprocedural readiness ensures patient care is aligned with their goals. Under-represented racial and ethnic groups often lack these important care plans.…”

“…Perioperative disparities may exist in how patients are assessed during preoperative evaluations. One study reported differences in cardiovascular assessment before bariatric surgery after adjusting for baseline cardiovascular risk, with white patients receiving more extensive cardiovascular testing than non-white patients 7 . Furthermore, white patients received more stress testing and shorter wait times for surgery than non-white patients even after adjusting for markers of socioeconomic status, including insurance provider and income 7 …”