Outcomes of Bariatric Surgery in African Americans: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Data Registry

Abstract

Background The incidence of obesity is disproportionally high in African Americans (AA) in the United States. This study compared outcomes for AA patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) with non-AA patients. Methods The MBSAQIP database was reviewed for RYGB and SG patients (2015-2017). Patients were identified as AA or non-AA and grouped to RYGB or SG. Combined and univariate analyses were performed on unmatched/propensity matched populations to assess outcomes. Results After applying exclusion criteria, 75,409 AA and 354,305 non-AA patients remained. Univariate analysis identified AA-RYGB and AA-SG patients were heavier and younger than non-AA patients. Overall, AA patients tended to have fewer preoperative comorbidities than non-AA patients with the majority of AA comorbidities related to hypertension and renal disease. Analysis of propensity matched data confirmed AA bariatric surgery patients had increased cardiovascular-related disease incidence compared with non-AA patients. Perioperatively, AA-RYGB patients had longer operative times, increased rates of major complications/ICU admission, and increased incidence of 30-day readmission, re-intervention, and reoperation, concomitant with lower rates of minor complications/superficial surgical site infection (SSI) compared with non-AA patients. For SG, AA patients had longer operative times and higher rates of major complications and 30-day readmission, re-intervention, and mortality, coupled with fewer minor complications, superficial/organ space SSI, and leak. Conclusion African American patients undergoing bariatric surgery are younger and heavier than non-AA patients and present with different comorbidity profiles. Overall, AAs exhibit worse outcomes following RYGB or SG than non-AA patients, including increased mortality rates in AA-SG patients.

Proximity to High/Moderate vs Low Diversity Selection Food Stores and Patient Weight loss through 24 Months

“…In this study, non-White patients (including a majority of Black patients) compared to White patients were more likely to live within proximity of at least one LD food store within a 5-min walk. Similar to other published work [ 17 , 18 ], non-White patients had less weight loss over 24 months compared to White patients. Finally, non-White patients within a 5-min proximity of at least one LD selection store also had less weight loss at 24 months compared to their non-White peers within proximity of no LD selections stores.…”

Association of Bariatric Surgery With Vascular Outcomes

“…Minority populations in the United States bear a disproportionate burden of the obesity epidemic and its associated comorbidities and tend to undergo fewer bariatric procedures compared with non-Hispanic White populations, which may be associated with socioeconomic factors, limited access to health care, and/or insurance options. 55 , 56 In addition, recent studies have identified race as an important factor associated with weight fluctuations, remission of obesity-related comorbidities, lower weight loss, and higher rates of hospital resource utilization and mortality after bariatric surgery. 57 , 58 , 59 , 60 , 61 , 62 , 63 In our current study, reversal of microvascular and macrovascular dysfunction was evident in both White participants and participants who identified as a minority racial/ethnic group, but the factors associated with vascular remodeling differed between races.…”

“… 57 , 58 , 59 , 60 , 61 , 62 , 63 In our current study, reversal of microvascular and macrovascular dysfunction was evident in both White participants and participants who identified as a minority racial/ethnic group, but the factors associated with vascular remodeling differed between races. Minority populations have been associated with lower hypertension remission and higher mortality rates, 56 , 58 , 59 , 62 , 63 which may partly relate to abnormalities in vascular tone. Racial differences may exist in their anatomical and physiological properties, which warrant further investigation.…”

Patient Access, Utilization, and Perceptions of Neighborhood and Built Environment Resources

“…Despite the established efficacy of bariatric surgery for long-term weight loss and comorbidity resolution[ 1 – 5 ], there are health inequity trends [ 6 ] in which patients identifying as racial/ethnic minorities and from economically disadvantaged backgrounds have poorer postoperative outcomes [ 7 – 10 ]. Specifically, Black/African American patients experience increased major postoperative complications, 30-day readmissions, re-intervention, reoperation, mortality, less weight loss, and lower attendance rates compared to non-Black/African American patients [ 7 , 11 – 14 ]. Patients of low socioeconomic status (i.e., lower income, receiving governmental social assistance, etc.)…”