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Published on: June 11, 2012
African American Patients Experience Worse Outcomes than Hispanic Patients Following Bariatric Surgery: an Analysis
Jordan N Robinson1, Sullivan A Ayuso1, Kyle J Thompson2
1Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 East 7th Street, NC, 28204, Charlotte, USA.
Insights
African American and Hispanic patients have higher obesity rates but undergo fewer bariatric surgeries. Post-surgery, African Americans experienced more complications than Hispanics, particularly with sleeve gastrectomy, indicating pre-existing factors influence outcomes.
Area of Science:
- Bariatric Surgery Outcomes
- Health Disparities in Obesity
- Surgical Patient Demographics
Background:
- Obesity disproportionately affects Hispanic and African American (AA) populations in the US.
- Metabolic and bariatric surgery (MBS) utilization remains lower in these ethnic groups compared to Caucasians.
Purpose of the Study:
- To compare patient demographics and surgical outcomes between adult AA and Hispanic patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB).
- To identify disparities in major complications and mortality rates between these populations post-MBS.
Main Methods:
- Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) dataset from 2015-2018.
- Inclusion of 173,157 adult patients (98,185 AA, 74,972 Hispanic) undergoing SG or RYGB.
- Utilized both unmatched and propensity-matched data to control for confounding variables.
Main Results:
- AA patients were older, had higher BMIs, and more comorbidities than Hispanic patients preoperatively.
- Intraoperative and postoperative complications, including ICU admission, 30-day readmission/reintervention, and mortality, were higher in AAs.
- After propensity matching, significant differences in complications persisted for both SG and RYGB, with SG showing more persistent disparities.
Conclusions:
- Outcomes for AA patients undergoing MBS were worse than for Hispanic patients, even after statistical matching.
- Sleeve gastrectomy outcomes showed more significant disparities between AA and Hispanic patients compared to Roux-en-Y gastric bypass.
- Pre-existing patient-related factors appear to significantly influence bariatric surgery outcomes, particularly for AA patients.
Background:
Obesity rates in Hispanics and African Americans (AAs) are higher than in Caucasians in the USA, yet the rate of metabolic and bariatric surgery (MBS) for weight loss remains lower for both Hispanics and AAs.
Methods:
Patient demographics and outcomes of adult AA and Hispanic patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) procedures were analyzed using the MBSAQIP dataset [2015-2018] using unmatched and propensity-matched data.
Results:
In total, 173,157 patients were included, of whom 98,185 were AA [56.7%] [21,163-RYGB; 77,022-SG] and 74,972 were Hispanic [43.3%] [20,282-RYGB; 54,690-SG]). Preoperatively, the AA cohort was older, had more females, and higher BMIs with higher rates of all tracked obesity-related medical conditions except for diabetes, venous stasis, and prior foregut surgery. Intra- and postoperatively, AAs were more likely to experience major complications including unplanned ICU admission, 30-day readmission/reintervention, and mortality. After propensity matching, the differences in ED visits, treatment for dehydration, 30-day readmission, 30-day intervention, and pulmonary embolism remained for both SG and RYGB cohorts. Progressive renal insufficiency and ventilator use lost statistical significance in both cohorts. Conversely, 30-day reoperation, postoperative ventilator requirement, unplanned intubation, unplanned ICU admission, and mortality lost significance in the RYGB cohort, but not SG patients.
Conclusion:
Outcomes for AA patients were worse than for Hispanic patients, even after propensity matching. After matching, differences in major complications and mortality lost significance for RYGB, but not SG. These data suggest that outcomes for RYGB may be driven by the presence and severity of pre-existing patient-related factors.
