Nicholas M Dugan, MD1, Selwan Barbat, MD1, Tanushree Prasad1, Kyle Thompson, PhD1, Iain Mckillop, PhD1, Sean Maloney, MD2, Amanda Roberts, MD1, Keith Gersin, MD, FACS, FASMBS1, Timothy Kuwada, MD, FACS, FASMBS1, Abdelrahman Nimeri, MD, FACS, FASMBS1. 1Carolinas Weight Management and Wellness Center, 2Carolinas Medical Center
Background: In the United States the rate of obesity and utilization of bariatric surgery has historically been higher in females than in males. Between 2005-2013 only 20% of bariatric surgeries were performed inn males. More recently (2015-2016) the CDC reported no significant difference between obesity prevalence amid genders. Additionally, male patients have historically been considered higher risk, presenting with more comorbidities and higher 30-day complication rates. The aim of this study is to examine the recent disparity between genders having sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) and to assess gender as an independent risk factor.
Methods: The MBSAQIPâ Data Registry Participant User Files for (2015-2016) was reviewed for patients having SG and RYGB. Patients were divided into groups based on gender and procedure performed. Exclusions were applied including revisional or emergent surgeries. Variables for major complications were grouped together, including but not limited to PE, stroke, and MI. Univariate and multivariate logistic regression analyses were performed.
Results: There were 301,605 cases, after exclusions were applied 279,419 cases remained. The patient population consisted of 79.2% female, 20.8% male, average BMI 45.5±8.1(kg/m2), average age 44.7±12.0yrs, 71.2% of cases were SG. A univariate analysis demonstrated that males were slightly older(46.79±11.9yrs vs 44.14±11.89yrs; p<0.0001), had clinically similar BMI(46.68±8.52(kg/m2) vs 45.17±7.90(kg/m2); p<0.0001), and had a significantly higher incidence of comorbidities compared to females (MI 3.04% vs 0.89%, Prior cardiac surgery 2.74% vs 0.74%, limited ambulation 2.19% vs 1.68%, HTN 63.3% vs 45.24%, renal insufficiency 1.42% vs 0.46%, DM on insulin 14.03% vs 7.52%, COPD 2.32% vs 1.65%, OSA 58.6% vs 32.49%; p<0.0001). Males also had higher rates of major complications (1.49% vs 0.81%) and 30-day mortality (0.19% vs 0.07%) compared to females; p<0.0001. Significance was maintained after subgroup analysis of SG and RYGB. Using a multivariate analysis controlling for MI history, COPD, prior cardiac surgery/procedure, OSA, renal insufficiency, HTN, and DM, demonstrated male gender was associated with an increased risk of major post-operative complications (1.31 AOR, 95%CI 1.20-1.43) and mortality (1.73 AOR, 95%CI 1.33-2.23) compared to females.
Conclusion: Despite the prevalence of obesity in males becoming statistically similar to females in recent years, the gender disparity among patients having bariatric surgery remains unchanged. Males still only represent approximately 20% of bariatric surgery patients, and present to surgery with significantly more comorbidities. Male gender is an independent risk factor for major post-operative complications and 30-day mortality, even after controlling for comorbidities.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95782
Program Number: S168
Presentation Session: Disparities
Presentation Type: Podium