African Americans Have Less Weight Loss and More Complications Following Bariatric Surgery

Linden A Karas, MD1, Madhu Siddeswarappa, MD1, Ananya Sinha1, Stephen D Slane, PhD2, Prashanth Ramachandra, MD1. 1Mercy Catholic Medical Center, 2Cleveland State University

Introduction: Recent research by groups led by W. Admiraal (2012), K.J. Coleman (2013) and others has examined the influence of ethnicity on outcomes of bariatric surgery. Most of these studies have concluded that excess weight loss (%EWL) is greater in Caucasians than in African Americans, though the majority of these studies included significantly more Caucasians than minority patients. This study examines differences in weight loss outcomes and complication rates following bariatric surgery as they vary by race in a uniquely diverse population composed of greater than sixty percent African Americans.

Methods: A review of a retrospectively compiled database of all patients who have undergone bariatric surgery at a community hospital Bariatric Center of Excellence in suburban Philadelphia, PA was performed. This cohort, diverse in both ethnicity and age, includes patients who underwent bariatric surgery (including laparoscopic and open gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and revisional surgery) between February 2012 and March 2014. Weight loss outcomes were gathered in the form of %EWL at one, three, six, nine, 12, 18, and 24-month intervals post-operatively. T-tests were performed to determine if weight loss or complication rates were different in Caucasians and African Americans.

Results: A cohort of 383 patients was studied. Early weight loss outcomes at one, three, six, and nine months were not significantly different between Caucasians and African Americans, however longer-term outcomes were. %EWL was significantly less in African Americans (146.48%) than in Caucasians (164.05%) at 1 year postoperatively (t=2.1, p=0.04). This difference was even greater at 1.5 years postoperatively (t=3.02, p=0.003) with average %EWL for Caucasians of 188.89% versus African Americans at 169.43%. African Americans were also found to have more frequent postoperative complications than Caucasians (t=-1.95, p=0.05), though the average complication rates are very low in both groups (0.27 for Caucasians and 0.41 for African Americans).

Conclusion: The population used for this study included more African Americans than any cohort used in prior research. Despite this high power, longer-term weight loss outcomes and complication rates remained worse for African Americans when compared with Caucasians. Interestingly, the trend in %EWL did not appear until one year postoperatively and the number or type of medical co-morbidity did not influence weight loss outcomes. Therefore, more analysis is necessary to determine the factors that adversely affect long-term weight loss outcomes in the African American population. Despite racial differences, bariatric surgery should be considered a safe and effective weight loss tool in the African American population.

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