Racial disparities in perioperative outcomes after metabolic and bariatric surgery: a case-control matched study

Background: Metabolic and bariatric surgery remains a safe and effective treatment for severe obesity. Ethnic minorities are disproportionately affected by obesity but are less likely to undergo metabolic and bariatric surgery. There remains controversy about outcomes among black patients compared with other ethnic groups after bariatric surgery.

Objective: The purpose of this case-control matched study using the largest clinically available bariatric data was to determine if there is racial disparity in perioperative outcomes after primary bariatric surgery.

Settings: University Hospital, United States.

Methods: Patients who had a primary Roux-en-Y gastric bypass or sleeve gastrectomy in 2015 to 2016 were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Case controlled-matched analyses were performed.

Results: We compared 80,238 equally matched nonHispanic black and white patients. Operative length and hospital stay were longer in black patients. All-cause mortality was 2-fold higher in black patients (P = .003). Black patients had significantly higher rates of 30-day readmission and reintervention (P < .0001), pulmonary embolism (P =.0004), and aggregate renal (P = .01) and venous thromboembolic (P = .001) complications. Postoperative myocardial infarction, cardiac arrest, pulmonary embolism, and all-cause mortality were significant higher in black patients after sleeve gastrectomy, but not Roux-en-Y gastric bypass.

Conclusion: In this study, pulmonary embolism and mortality were significantly higher in black patients after sleeve gastrectomy. Further studies are needed to determine causality.