Examining Racial Differences in Outcomes After Bariatric Surgery

Doctor checking weight of patient.
Doctor checking weight of patient.
Researchers found a significantly higher rate of short-term complications and resource utilization for black patients compared with white patients after bariatric surgery.

In a retrospective study comparing racial differences in bariatric surgery, researchers found a significantly higher rate of short-term complications and resource utilization in black patients compared with white patients. In addition, weight loss at 1 year post-surgery, quality of life, and satisfaction were lower in black patients. However, there were no racial differences in serious complications or mortality rates, according to study results published in JAMA Surgery.

Data from the Michigan Bariatric Surgery Collaborative were used to study the association between race and perioperative and 1-year outcomes of bariatric surgery. The researchers collected data on patients who underwent surgery between June 2006 and January 2017 and investigated 30-day complications and healthcare resource utilization, as well as weight loss, quality of life, satisfaction, and remission of various comorbidities 12 months after surgery.

The cohort included 7105 black and 7105 white patients (mean age, 44 and 43 years, respectively; mean body mass index, 50 and 49 kg/m2, respectively). Sleeve gastrectomy was the most common bariatric surgery in black (3886 patients, 55%) and white patients (3801 patients, 54%), followed by gastric bypass (2418 patients [34%] and 2350 patients [33%], respectively) and adjustable gastric band (801 patients [11%] and 954 patients [13%], respectively).

The results showed that black patients had a significantly higher risk for 30-day complications compared with white patients (8.8% vs 6.8%, respectively; adjusted odds ratio [aOR], 1.33; 95% CI, 1.17-1.51; P =.02). However, there was no significant racial difference in the risk for serious complications (2.5% vs 1.9%, respectively) or mortality (0.1% in each group).

Investigation of healthcare resource utilization measures revealed that black patients were at increased risk for readmission (5.8% vs 3.5%; aOR, 1.73; 95% CI, 1.47-2.03) and emergency department visits (11.6% vs 7.6%; aOR, 1.60; 95% CI, 1.43-1.79) and had longer hospital stays (mean 2.2 days vs 1.9 days) compared with white patients.

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One year after bariatric surgery, overall weight loss as percentage of weight was significantly less in black compared with white patients (average weight loss of 32.0 kg [26%] vs 38.3 kg [29%], respectively; P <.001). Furthermore, weight loss in black patients was significantly lower 1 year following all 3 bariatric procedures included in this study: Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding.

Following surgery, remission rates for hypertension were lower in black patients compared with white patients (40% vs 56%, respectively; P <.001), but remission rates for gastroesophageal reflux disease (79% vs 75%; P =.049) and sleep apnea (63% vs 56%; P =.005) were significantly greater in black patients. Remission rates of diabetes and hyperlipidemia were not different between the groups.

Satisfaction with the surgery was high in both groups, but more so in white patients (84% vs 78%; P <.001). In a similar fashion, quality of life was reported as good or very good after surgery in the majority of both patient groups, with slightly better results in white patients (90% vs 87%; P =.002).

There are several possible limitations to this study, according to the researchers, including unmeasured factors such as disease duration and severity. In addition, quality of life and satisfaction scores were not based on validated instruments.

“[T]here are significant racial disparities in perioperative outcomes, weight loss, and quality of life after bariatric surgery. While biological differences may explain some of the disparity in outcomes, environmental, social, and behavioral factors are likely [to] play a role,” concluded the researchers.

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Wood MH, Carlin AM, Ghaferi AA, et al. Association of race with bariatric surgery outcomes [published online March 6, 2019]. JAMA Surgery. doi:10.1001/jamasurg.2019.0029