Advertisement

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

  • Haleh Amirian
  • Alfonso Torquati
  • Philip OmotoshoEmail author
Original Contributions
  • 28 Downloads

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, re-intervention, 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.

Keywords

Racial disparities Perioperative outcomes 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study has received exempt IRB approval from Rush University Medical Center IRB. For this type of study, formal consent is not required.

References

  1. 1.
    Centers for Disease Control and Prevention. National center for chronic disease prevention and health promotion, division of nutrition, physical activity, and obesity. Data, Trend and Maps [online];201903/07.Google Scholar
  2. 2.
    MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated gastric bypass. Ann Surg. 231(4)CrossRefGoogle Scholar
  3. 3.
    O’Brien PE, Hindle A, Brennan L, et al. Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg. 29(1)CrossRefGoogle Scholar
  4. 4.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 222(3)CrossRefGoogle Scholar
  5. 5.
    Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 232(4)CrossRefGoogle Scholar
  6. 6.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 351(26)CrossRefGoogle Scholar
  7. 7.
    Chen Y, Corsino L, Shantavasinkul PC, et al. Gastric bypass surgery leads to long-term remission or improvement of type 2 diabetes and significant decrease of microvascular and macrovascular complications. Ann Surg. 263(6)CrossRefGoogle Scholar
  8. 8.
    Omotosho P, Mor A, Shantavasinkul PC, et al. Gastric bypass significantly improves quality of life in morbidly obese patients with type 2 diabetes. Surg Endosc. 30(7)CrossRefGoogle Scholar
  9. 9.
    Turrell G, Vandevijvere S. Socio-economic inequalities in diet and body weight: evidence, causes and intervention options. Public Health Nutr. 18(5)CrossRefGoogle Scholar
  10. 10.
    Parikh M, Hetherington J, Sheth S, et al. Frequencies of obesity susceptibility alleles among ethnically and racially diverse bariatric patient populations. Surg Obes Relat Dis. 9(3)CrossRefGoogle Scholar
  11. 11.
    Buffington CK, Marema RT. Ethnic differences in obesity and surgical weight loss between African-American and Caucasian females. Obes Surg. 16(2)CrossRefGoogle Scholar
  12. 12.
    Fuchs HF, Broderick RC, Harnsberger CR, et al. Benefits of bariatric surgery do not reach obese men. J Laparoendosc Adv Surg Tech A. 25(3)CrossRefGoogle Scholar
  13. 13.
    Bhogal SK, Reddigan JI, Rotstein OD, et al. Inequity to the utilization of bariatric surgery: a systematic review and meta-analysis. Obes Surg. 25(5)CrossRefGoogle Scholar
  14. 14.
    Lutfi R, Torquati A, Sekhar N, et al. Predictors of success after laparoscopic gastric bypass: a multivariate analysis of socioeconomic factors. Surg Endosc. 20(6)CrossRefGoogle Scholar
  15. 15.
    Anderson WA, Greene GW, Forse RA, et al. Weight loss and health outcomes in African Americans and whites after gastric bypass surgery. Obesity (Silver Spring). 15(6)CrossRefGoogle Scholar
  16. 16.
    Omotosho PA, Rodriguez JA, Jain-Spangler K, et al. Predictors of long-term success after laparoscopic Roux-en-Y gastric bypass in African-American women. Surg Obes Relat Dis. 12(2)CrossRefGoogle Scholar
  17. 17.
    MBSAQIP Participant use data file;2018March/22.Google Scholar
  18. 18.
    Sheka AC, Kizy S, Wirth K, et al. Racial disparities in perioperative outcomes after bariatric surgery. Surg Obes Relat Dis. Google Scholar
  19. 19.
    Nguyen GC, Patel AM. Racial disparities in mortality in patients undergoing bariatric surgery in the U.S.A. Obes Surg. 23(10)CrossRefGoogle Scholar
  20. 20.
    Wahl TS, Goss LE, Morris MS, et al. Enhanced recovery after surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery. Ann Surg. 268(6)CrossRefGoogle Scholar
  21. 21.
    Tiwari MM, Goede MR, Reynoso JF, et al. Differences in outcomes of laparoscopic gastric bypass. Surg Obes Relat Dis. 7(3)Google Scholar
  22. 22.
    Sun SX, Hollenbeak CS, Rogers AM. Readmissions following gastric bypass surgery. Obes Surg. 26(2)CrossRefGoogle Scholar
  23. 23.
    Abraham A, Ikramuddin S, Jahansouz C, et al. Trends in bariatric surgery: procedure selection, revisional surgeries, and readmissions. Obes Surg. 26(7)CrossRefGoogle Scholar
  24. 24.
    Garg T, Rosas U, Rivas H, et al. National prevalence, causes, and risk factors for bariatric surgery readmissions. Am J Surg. 212(1)CrossRefGoogle Scholar
  25. 25.
    Turner PL, Oyetunji TA, Gantt G, et al. Demographically associated variations in outcomes after bariatric surgery. Am J Surg. 201(4)CrossRefGoogle Scholar
  26. 26.
    Worni M, Guller U, Maciejewski ML, et al. Racial differences among patients undergoing laparoscopic gastric bypass surgery: a population-based trend analysis from 2002 to 2008. Obes Surg. 23(2)CrossRefGoogle Scholar
  27. 27.
    Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services.Google Scholar
  28. 28.
    Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among adults: United States, 2015-2016. NCHS Data Brief. (289)289.Google Scholar
  29. 29.
    Dallal RM, Bailey L, Guenther L, et al. Comparative analysis of short-term outcomes after bariatric surgery between two disparate populations. Surg Obes Relat Dis. 4(2)CrossRefGoogle Scholar
  30. 30.
    Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 294(15)CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Graduate CollegeRush UniversityChicagoUSA
  2. 2.Division of Minimally Invasive and Bariatric SurgeryRush University Medical CenterChicagoUSA

Personalised recommendations