Association of Race With Bariatric Surgery Outcomes

Area of Science:

• Bariatric Surgery Outcomes
• Health Disparities
• Surgical Complications

Background:

• Outcomes of bariatric surgery vary significantly among patients.
• The association between race and bariatric surgery outcomes remains unclear.

Purpose of the Study:

• To examine the association of race on perioperative and 1-year outcomes of bariatric surgery.
• Investigate differences in complications, resource utilization, weight loss, and comorbidity remission between Black and White patients.

Main Methods:

• Propensity score matching was used to create balanced cohorts of Black and White patients.
• Included primary bariatric operations (gastric bypass, sleeve gastrectomy, adjustable gastric banding) from June 2006 to January 2017.
• Conditional fixed-effects models evaluated the association of race on outcomes within hospitals and surgeons.

Main Results:

• Black patients had higher rates of any 30-day complication (8.8% vs 6.8%) and increased healthcare resource utilization, including longer hospital stays and higher readmission rates.
• At 1 year, Black patients achieved lower mean total body weight loss (26% vs 29%) and lower hypertension remission rates (40.0% vs 56.0%).
• Higher remission rates for sleep apnea (62.6% vs 56.1%) and gastroesophageal reflux disease (78.6% vs 75.4%) were observed in Black patients. Quality of life and satisfaction were lower in Black patients.

Conclusions:

• Black patients undergoing bariatric surgery in Michigan experienced higher 30-day complication rates and greater resource utilization compared to matched White patients.
• Lower weight loss and hypertension remission were noted in Black patients, though sleep apnea and GERD remission were higher.
• Racial and cultural factors should be considered in strategies to optimize bariatric surgery outcomes.