Amanda Roberts, MD1, Nicholas Dugan1, Tanushree Prasad2, Kyle Thompson, PhD2, Selwan Barbat, MD1, Sean Maloney, MD, FACS, FASMBS2, Keith Gersin, MD, FACS, FASMBS1, Timothy Kuwada, MD, FACS, FASMBS1, Abdelrahman Nimeri, MD, FACS, FASMBS1. 1Carolinas Weight Management, 2Carolinas Medical Center
Background: According to the Centers for Disease Control and Prevention (CDC), almost 40% of the Unites States population in 2016 was obese. Of these, a larger proportion were minorities, especially Hispanic and African American. Several factors, including race and access to care, may affect the choice and ability to undergo bariatric surgery, as well as outcomes. This study aimed to examine the MBSASQIP Data Registry for racial disparities in adults having sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).
Methods: The MBSAQIP Data Registry Participant User Files (2015-2016) were reviewed for patients having SG and RYGB. Patients were grouped by race (Hispanic vs all other races; African American vs all other races) and procedure performed. Revisional procedures were excluded. Variables were combined into major (PE, CVA, MI) or minor (surgical site occurrences). Univariate and multivariate logistic regression analyses were performed.
Results: There were 301,605 cases and after applying exclusions, 279,419 remained. The frequency of both SG and RYGB among races was vastly different than the nationwide prevalence of obesity, with Whites over-represented and African Americans and Hispanics under-represented. A univariate analysis showed that compared to all other races, Hispanics have the lowest comorbidity profile; they are younger and have a lower BMI. Thirty-day mortality when undergoing SG is lower as well (0.03% vs 0.09%, p<0.001). African Americans undergoing RYGB have the the most comorbidities and are more likely to have an unplanned ICU admission (1.41% vs 1.17%, P=0.0382) or reoperation (2.67% vs 2.24%, p= 0.0047) within the first 30 days compared to all other races. African Americans undergoing SG have a higher 30-day mortality (0.13 vs 0.07%, P<0.001). Hispanics undergoing RYGB had significantly less minor complications (0.11% vs 0.22%, p=0.0275). African Americans have higher rates of major complications (1.85% vs 1.51%, p=0.0072 RYGB, 0.96% vs 0.70% SG, p<0.001) while Hispanics have lower risk (1.0% vs 1.62%, p<0.001 RYGB, 0.47% vs 0.8% SG, p<0.001). This held true when a multivariate analysis was completed, correcting for significant comorbidities, demonstrating increased risk of major complications (2.21 AOR, 95%CI 0.81 – 8.99 SG; 1.06 AOR, 95%CI 0.51 – 2.72 RYGB) for African Americans but decreased risk (0.81 AOR, 95%CI 0.65 – 1.00 SG; 0.87 AOR, 95%CI 0.69 – 1.08 RYGB) in Hispanics compared to all other races.
Conclusion: Hispanic patients undergoing SG and RYGB are healthier overall than all other races and have decreased major complications. African Americans have more comorbidities and major complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95906
Program Number: S163
Presentation Session: Disparities
Presentation Type: Podium