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Do outcomes of bariatric surgery differ between black and white patients?
This study of 14 000 propensity-matched black and white patients undergoing bariatric surgery in Michigan demonstrated that black patients had higher overall rates of complications and health care resource utilization within 30 days of surgery. While weight loss at 1 year was slightly lower in black patients, comorbidity remission was similar between patient cohorts.
This study suggests that short-term and long-term outcomes after bariatric surgery differ by race, and these differences should be considered when developing strategies to optimize results in patients undergoing weight-loss procedures.
The outcomes of bariatric surgery vary considerably across patients, but the association of race with these measures remains unclear.
To examine the association of race on perioperative and 1-year outcomes of bariatric surgery.
Design, Setting, and Participants
Propensity score matching was used to assemble cohorts of black and white patients from the Michigan Bariatric Surgery Collaborative who underwent a primary bariatric operation (Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding) between June 2006 and January 2017. Cohorts were balanced on baseline characteristics and procedure. Conditional fixed-effects models were used to evaluate the association of race on outcomes within hospitals and surgeons. Data analysis occurred from June 2006 through August 2018.
Main Outcomes and Measures
Thirty-day complications and health care resource utilization measures, as well as 1-year weight loss, comorbidity remission, quality of life, and satisfaction.
In each group, 7105 patients were included. Black patients had a higher rate of any complication (628 [8.8%] vs 481 [6.8%]; adjusted odds ratio, 1.33 [95% CI, 1.17-1.51]; P = .02), but there were no significant differences in the rates of serious complications (178 [2.5%] vs 135 [1.9%]; adjusted odds ratio, 1.32 [95% CI, 1.05-1.66]; P = .29) or mortality (5 [0.10%] vs 7 [0.10%]; adjusted odds ratio, 0.73 [95% CI, 0.23-2.31]; P = .54). Black patients had a greater length of stay (mean [SD], 2.2 [3.0] days vs 1.9 [1.7] days; adjusted odds ratio, 0.30 [95% CI, 0.20-0.40]; P < .001), as well as a higher rate of emergency department visits (541 [11.6%] vs 826 [7.6%]; adjusted odds ratio, 1.60 [95% CI, 1.43-1.79]; P < .001) and readmissions (414 [5.8%] vs 245 [3.5%]; adjusted odds ratio, 1.73 [95% CI, 1.47-2.03]; P < .001). At 1 year, black patients had lower mean total body weight loss and as a percentage of weight (32.0 kg [26%]; vs 38.3 kg [29%]; P < .001) and this held true across procedures. Remission of hypertension was lower for black patients (564 [40.0%] vs 1096 [56.0%]; P < .001), but the rate of sleep apnea remission (467 [62.6%] vs 615 [56.1%]; P = .005) and gastroesophageal reflux disease (309 [78.6%] vs 453 [75.4%]; P = .049) were higher. There were no significant differences in remission of diabetes with insulin dependence, diabetes without insulin dependence,or hyperlipidemia hyperlipidemia. Fewer black patients than white patients reported a good or very good quality of life (1379 [87.2%] vs 2133 [90.4%]; P = .002) and being very satisfied with surgery (1908 [78.4%] vs 2895 [84.2%]; P < .001) at 1 year.
Conclusions and Relevance
Black patients undergoing bariatric surgery in Michigan had significantly higher rates of 30-day complications and resource utilization and experienced lower weight loss at 1 year than a matched cohort of white patients. While sleep apnea and gastroesophageal reflux disease remission were higher and hypertension remission lower in black patients, comorbidity remission was otherwise similar between matched cohorts. Racial and cultural differences among patients should be considered when designing strategies to optimize outcomes with bariatric surgery.
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Corresponding Author: Jonathan F. Finks, MD, Department of Surgery, University of Michigan Health Systems, 1500 E Medical Center Dr, 2926 Taubman Center, Ann Arbor, MI 48109 (firstname.lastname@example.org).
Accepted for Publication: December 6, 2018.
Published Online: March 6, 2019. doi:10.1001/jamasurg.2019.0029
Correction: This article was corrected on June 5, 2019, to fix an incorrectly stated income bracket. In both Table 1 and the Results section, the income range “$45 000-$75 999” should have been written “$45 000-$75 000.” The error has been corrected.
Author Contributions: Dr Finks had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Wood, Carlin, Ghaferi, Birkmeyer, Finks.
Acquisition, analysis, or interpretation of data: Carlin, Varban, Hawasli, Bonham, Birkmeyer, Finks.
Drafting of the manuscript: Wood, Bonham, Birkmeyer, Finks.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Bonham, Birkmeyer, Finks.
Obtained funding: Ghaferi, Birkmeyer.
Administrative, technical, or material support: Wood, Ghaferi, Finks.
Supervision: Wood, Carlin, Ghaferi, Finks.
Conflict of Interest Disclosures: Drs Finks, Varban, and Ghaferi receive salary support from Blue Cross Blue Shield Michigan/Blue Care Network for their role in the leadership of the Michigan Bariatric Surgery Collaborative. Dr Carlin receives an honorarium from Blue Cross Blue Shield Michigan/Blue Care Network for his role as Executive Committee Chair of the Michigan Bariatric Surgery Collaborative. No other disclosures were reported.
Funding/Support: This work was funded by Blue Cross Blue Shield Michigan/ Blue Care Network.
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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