Identifying drivers of disparities in post-surgical healthcare resource utilization for bariatric surgery

Racial and ethnic minority patients undergoing bariatric surgery experience a disproportionate number of unfavorable outcomes. The drivers of these differences have been attributed to differences in comorbidities, socioeconomic factors, access to postoperative care, and cultural considerations. We aimed to explore healthcare disparities among bariatric surgery patients in our institution.

A retrospective cohort analysis of bariatric surgery patients at a MBSAQIP-accredited bariatric surgery center was conducted over three years. Patient demographics, preoperative comorbidities, and post-operative healthcare utilization and complication rates were stratified according to race. A logistic regression model assessed associations between race and ethnicity and post operative resource utilization, adjusting for demographic, social determinants of health, preoperative risk factors and procedural differences.

A total of 1,408 patients were included, with 60.6% White, 32.8% Black, 0.7% Asian, 5.4% other/unknown. Preoperative risk factors differed slightly across racial groups. Postoperatively, there was minimal difference in the cohorts' complications but when compared with White patients, Black patients had an increased length of stay (1.55 versus 1.34 days, p < 0.001), were more likely to be readmitted (OR = 2.64, 95%CI = 1.26-5.56, p = 0.011), and increased use of ambulatory IV fluid treatment (10% versus 2.7%, p < 0.001).

Despite similar preoperative risk factors and postoperative complications, Black patients experienced a longer length of stay, an increased use of IV fluid treatment, and a higher likelihood of readmission within 30 days after bariatric surgery. Race was associated with both higher length of stay and readmission rate highlighting the need for further investigation into the contributing factors and identification of targets to reduce disparities in bariatric care.