Racial Disparity in 30-Day Outcomes of Metabolic and Bariatric Surgery

Abstract

Background There is evidence of racial disparity in the long-term weight loss outcomes of bariatric surgery. However, there has been a more limited evaluation of the impact of race on immediate perioperative outcomes. The aim of this study was to compare 30-day postoperative outcomes among different races. Study Design The 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was queried to identify patients aged ≥ 18 and body mass index ≥ 35 who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) with known information on race. We then evaluated the effect of five different races on four different 30-day outcomes. Results Of the total 106,932 patients (79.5% White, 19.3% African American (AA), 0.5% Asian, 0.4% American Indian or Alaska Native, 0.3% Native Hawaiian or other Pacific Islander), 30-day rates of postoperative complication, readmission, reintervention, and reoperation were 6, 3.8, 1.3, and 1.2%, respectively. After controlling for other covariates in multivariate logistic regression and selecting White as reference, AA was the only race associated with a higher risk of postoperative complications (odds ratio [OR] 1.13; confidence interval [CI] 1.06-1.2) and readmissions (OR 1.47; CI 1.3-1.6). AA and American Indian or Alaska Native were also associated with higher re-interventions (OR 1.31; CI 1.15-1.51 and OR 2.11; CI 1.03-4.34). Furthermore, AA was associated with lower 30-day reoperations (OR 0.83; CI 0.7-0.9). Conclusion This study found significant racial differences in short-term outcomes following bariatric surgery. Factors underlying these disparities are unclear and warrant further investigation.

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

“…As reflected in our analysis of unmatched patient data, the Michigan collaborative study reported AA patients had a higher rate of any complication (although no differences in serious complications or mortality were identified), higher rates of emergency department visits, and higher incidence of readmission [11]. When looking at post-operative outcomes Amirian et al (using MBSAQIP data from 2016) report similar findings to us, whereby AA patients had worse outcomes, including higher postoperative complications, readmission, and reoperations [12], while Tiwari et al, using the University HealthSystem Consortium (UHC) database, also report AA patients were at increased risk of adverse events following a laparoscopic RYGB procedure [13]. Examining mortality after bariatric surgery, Nguyen et al report AA patients had significantly higher mortality compared with non-Hispanic whites (3.7 vs 2.3 per 1000 procedures, P < 0.01), although their analysis compared non-Hispanic AAs vs non-Hispanic whites and did not include matching and did not compare RYGB and SG separately [14].…”

Persistent Racial Disparities in Deep Brain Stimulation for Parkinson's Disease

“…One recent study found that White and non‐White patients with PD were similarly likely to be routinely discharged following DBS surgery 13 . However, there is evidence that postoperative outcomes (including length of stay and complications) are worse for Black patients compared with White patients following a range of major surgeries 14–18 . Black patients also have higher postoperative mortality rates 19–21 .…”

“…13 However, there is evidence that postoperative outcomes (including length of stay and complications) are worse for Black patients compared with White patients following a range of major surgeries. [14][15][16][17][18] Black patients also have higher postoperative mortality rates. [19][20][21] Therefore, to what extent surgeon/institutional experience with racial disparities in outcome following DBS surgery may play a role in patient selection is unclear and should be explored in future analyses examining factors underlying the disparities in DBS for PD.…”

Persistent racial disparities in deep brain stimulation for Parkinson’s disease

“…13 However, there is evidence that postoperative outcomes (including length of stay and complications) are worse for Black patients compared to White patients following a range of major surgeries. [14][15][16][17][18] Black patients also have higher postoperative mortality rates. [19][20][21] Therefore, to what extent surgeon/institutional experience with racial disparities in outcome following DBS surgery may play a role in patient selection is unclear and should be explored in future analyses examining factors underlying the disparities in DBS for PD.…”