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Bariatric Surgery, Clinical Outcomes, and Healthcare Burden in Hispanics in the USA

  • Paul T. Kröner FloritEmail author
  • Juan E. Corral Hurtado
  • Karn Wijarnpreecha
  • Enrique F. Elli
  • Frank J. Lukens
Original Contributions
  • 53 Downloads

Abstract

Introduction/Purpose

Bariatric surgery (BS) has emerged as a cornerstone procedure to prevent and treat obesity-related comorbidities. As the Hispanic population continues to grow in the USA, their importance to the healthcare system cannot be understated. We aimed to assess the use of BS and related healthcare outcomes in Hispanics using a national database.

Materials and Methods

Case-control study using the 2010 to 2014 National Inpatient Sample datasets. BS use in Hispanics compared to non-Hispanics was the primary outcome. Secondary outcomes included inpatient mortality, morbidity, resource use, length of hospital stay, hospital costs, and total hospitalization charges. Propensity scores were used to match Hispanic patients with BS with non-Hispanic patients with BS using sex, age, and Charlson Comorbidity Index as covariates. A multivariate model was then used to adjust for additional confounding factors.

Results

From the 105,435 patients who underwent BS, a propensity-matched cohort of 20,440 was created (10,945 Hispanics). Mean (SD) age was 45 (17.2) years, and 73,594 (69.8%) were women. The prevalence of BS in Hispanics was 21/100,000 persons (281/100,000 admissions) compared to 36/100,000 persons (337/100,000 admissions) for non-Hispanics. On multivariate analysis, Hispanics displayed adjusted propensity-matched odds of 0.88 of having BS (P < 0.01). No differences were seen in the surgical approach performed. Hispanics and non-Hispanics had similar mortality, morbidity, hospital length of stay, and costs.

Conclusion

Despite higher obesity rates, the use of BS is lower in Hispanics. For those who underwent BS, no difference in clinical outcomes and minor differences in resource use were observed.

Keywords

Bariatric surgery Ethnic disparities Obesity Outcomes research 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflict of interests.

Ethics Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent was not required.

References

  1. 1.
    KYZ F, Leeds MJ, Ufelle AC. Epidemiology of obesity in the Hispanic adult population in the United States. Fam Community Health. 2017;40(4):291–7.  https://doi.org/10.1097/FCH.0000000000000160.CrossRefGoogle Scholar
  2. 2.
    U.S. Department of Commerce EaSA. Population profile of the United States: dynamic version. Living, working, and growing in the USA: U.S. Census Bureau; 2003. Available from: https://www.census.gov/population/pop-profile/dynamic/profiledynamic.pdf. Accessed Feb 27 2019.
  3. 3.
    Clemetson L. Hispanics now largest minority, census shows. The New York Times. 2003; 1/22/2003:A00001.Google Scholar
  4. 4.
    Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313(1):62–70.  https://doi.org/10.1001/jama.2014.16968.CrossRefGoogle Scholar
  5. 5.
    Stanford FC, Jones DB, Schneider BE, et al. Patient race and the likelihood of undergoing bariatric surgery among patients seeking surgery. Surg Endosc. 2015;29(9):2794–9.  https://doi.org/10.1007/s00464-014-4014-8.CrossRefGoogle Scholar
  6. 6.
    Wee CC, Huskey KW, Bolcic-Jankovic D, et al. Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity. J Gen Intern Med. 2014;29(1):68–75.  https://doi.org/10.1007/s11606-013-2603-1.CrossRefGoogle Scholar
  7. 7.
    Byrd AS, Toth AT, Stanford FC. Racial disparities in obesity treatment. Curr Obes Rep. 2018;7(2):130–8.  https://doi.org/10.1007/s13679-018-0301-3.CrossRefGoogle Scholar
  8. 8.
    Sudan R, Winegar D, Thomas S, et al. Influence of ethnicity on the efficacy and utilization of bariatric surgery in the USA. J Gastrointest Surg. 2014;18(1):130–6.  https://doi.org/10.1007/s11605-013-2368-1.CrossRefGoogle Scholar
  9. 9.
    Khera R, Krumholz HM. With great power comes great responsibility: big data research from the National Inpatient Sample. Circ Cardiovasc Qual Outcomes. 2017;10(7):e003846.  https://doi.org/10.1161/CIRCOUTCOMES.117.003846.CrossRefGoogle Scholar
  10. 10.
    HCUP Databases. Healthcare cost and utilization project—overview of the National (Nationwide) Inpatient Sample (NIS) Agency for Healthcare Research and Quality. Rockville, MD. 2016.Google Scholar
  11. 11.
    Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613–9.CrossRefGoogle Scholar
  12. 12.
    Kroner PT, Koop A, Stewart M, et al. 792—Hispanic ethnicity is associated with decreased odds of bariatric surgery: a nationwide analysis. Gastroenterology. 2018;154(6, Supplement 1):S-1358–S-9.  https://doi.org/10.1016/S0016-5085(18)34444-5.CrossRefGoogle Scholar
  13. 13.
    Khera R, Angraal S, Couch T, et al. Adherence to methodological standards in research using the National Inpatient Sample. JAMA. 2017;318(20):2011–8.  https://doi.org/10.1001/jama.2017.17653.CrossRefGoogle Scholar
  14. 14.
    Le A, Judd SE, Allison DB, et al. The geographic distribution of obesity in the US and the potential regional differences in misreporting of obesity. Obesity (Silver Spring). 2014;22(1):300–6.  https://doi.org/10.1002/oby.20451.CrossRefGoogle Scholar
  15. 15.
    Istfan N, Anderson WA, Apovian C, et al. Racial differences in weight loss, hemoglobin A1C, and blood lipid profiles after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2016;12(7):1329–36.  https://doi.org/10.1016/j.soard.2015.12.028.CrossRefGoogle Scholar
  16. 16.
    Coleman KJ, Huang YC, Koebnick C, et al. Metabolic syndrome is less likely to resolve in Hispanics and non-Hispanic blacks after bariatric surgery. Ann Surg. 2014;259(2):279–85.  https://doi.org/10.1097/SLA.0000000000000258.CrossRefGoogle Scholar
  17. 17.
    Dominguez K, Penman-Aguilar A, Chang MH, et al. Vital signs: leading causes of death, prevalence of diseases and risk factors, and use of health services among Hispanics in the United States: 2009-2013. MMWR Morb Mortal Wkly Rep. 2015;64(17):469–78.Google Scholar
  18. 18.
    Hainer V, Aldhoon-Hainerová I. Obesity paradox does exist. Diabetes Care. 2013;36(Suppl 2):S276–81.  https://doi.org/10.2337/dcS13-2023.CrossRefGoogle Scholar
  19. 19.
    Elli EF, Gonzalez-Heredia R, Patel N, et al. Bariatric surgery outcomes in ethnic minorities. Surgery. 2016;160(3):805–12.  https://doi.org/10.1016/j.surg.2016.02.023.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Paul T. Kröner Florit
    • 1
    Email author
  • Juan E. Corral Hurtado
    • 1
  • Karn Wijarnpreecha
    • 1
  • Enrique F. Elli
    • 2
  • Frank J. Lukens
    • 1
  1. 1.Division of Gastroenterology and HepatologyMayo ClinicJacksonvilleUSA
  2. 2.Division of General SurgeryMayo ClinicJacksonvilleUSA

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