Outcomes in racial minorities after robotic Roux-en-Y gastric bypass and sleeve gastrectomy: a retrospective review of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database

Outcomes After Damage Control Laparotomy Among White, American Indian, and Alaska Native Populations

BackgroundAmerican Indian and Alaska Native (AIAN) populations have been shown to have severe health disparities, with increased 30-day mortality rates and surgical complications. They continue to represent a population that has the worst outcomes, however, still underrepresented within the medical literature. Further research into AIAN is critical to start to determine why these differences exist.MethodsA retrospective review of patients undergoing damage control laparotomies (DCLs) between 2015 and 2024 was conducted. Logistic regression was used to compare variables (age, race, gender, ASA, APACHE II, ICU admission, ventilation, number of operations, and time until abdominal closure).ResultsA total of 502 patients were included in the analysis. 10% of these were AIAN. The AIANs undergoing DCL had a mean age of 47.5 years, whereas White patients had a mean age of 62.1 years (P < 0.0001). There were no statistically significant differences in mortality rates. Non-mortality complications were equally distributed between the 2 groups. Logistic regression analysis identified age, APACHE II score, and procedure count as significant predictors of mortality.ConclusionsAmerican Indians are presenting at notably younger ages compared to their White counterparts (62 vs 48 years old). Despite comparable outcomes between the groups, this highlights a distinct age-related gap within our AIAN population, underscoring the necessity for heightened care in this specific patient demographic.

The impact of the COVID-19 pandemic on racial disparities in postoperative outcomes after bariatric surgery

BACKGROUND

The COVID-19 pandemic has affected the outcomes and access to elective surgery across the United States. This study hypothesized that preexisting racial and ethnic disparities were exacerbated by the pandemic for bariatric surgery.

METHODS

This retrospective cohort study evaluated the outcome disparities in 1,046,578 patients who underwent bariatric surgery from 2016-2019 (before the COVID-19 pandemic) to 2020-2021 (during the COVID-19 pandemic) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. The primary outcomes of interest, Clavien-Dindo (CD) scores (0-5) and extended length of stay (eLOS; >90th percentile), were compared between non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, and non-Hispanic Asian/American Indian/Pacific Islander (A/AI/PI) patients using ordinal and binomial logistic regression models, respectively. In addition, the modifying effect of COVID-19 on racial disparities in these outcomes was assessed.

RESULTS

Overall, patients during the COVID-19 pandemic had higher odds of a higher CD score (odds ratio [OR], 1.05; 95% CI, 1.04-1.06; P < .001) than patients before the COVID-19 pandemic on adjusted multivariate analysis. NHB patients were more likely to experience postoperative complications as characterized by higher CD scores (OR, 1.37; 95% CI, 1.35-1.39; P < .001) than NHW patients, and COVID-19 was a contributory factor (ratio of ORs, 1.07; 95% CI, 1.05-1.10). There was no significant difference in CD scores in Hispanic (OR, 1.00; 95% CI, 0.98-1.03; P = .800) and A/AI/PI (OR, 0.98; 95% CI, 0.92-1.06; P = .651) patients compared with NHW patients, and COVID-19 did not have a modifying effect on these patients. All non-White patients had a higher likelihood of eLOS before the COVID-19 pandemic, but COVID-19 had a modifying effect of decreased odds of eLOS for all races (ratio of ORs, 0.60-0.69; 95% CI, 0.56-0.80).

DISCUSSION

NHB patients had inferior perioperative outcomes than patients of other races after bariatric surgery during the COVID-19 pandemic. In addition, all races/ethnicities had decreased odds of eLOS during the COVID-19 pandemic.

Racial disparities in complications following elective colon cancer resection: Impact of laparoscopic versus robotic approaches

BACKGROUND

We sought to examine differences in outcomes for Black and White patients undergoing robotic or laparoscopic colectomy to assess the potential impact of technological advancement.

METHODS

We queried the ACS-NSQIP database for elective robotic (RC) and laparoscopic (LC) colectomy for cancer from 2012 to 2020. Outcomes included 30-day mortality and complications. We analyzed the association between outcomes, operative approach, and race using multivariable logistic regression.

RESULTS

We identified 64,460 patients, 80.9% laparoscopic and 19.1% robotic. RC patients were most frequently younger, male, and White, with fewer comorbidities (P ​< ​0.001). After adjustment, there was no difference in mortality by approach or race. Black patients who underwent LC had higher complications (OR 1.10, 95% CI 1.03-1.08, P ​= ​0.005) than their White LC counterparts and RC patients.

CONCLUSIONS

Robotic colectomy was associated with lower rates of complications in minority patients. Further investigation is required to identify the causal pathway that leads to our finding.

Disparities and Risk Factors for Surgical Complication in American Indians and Native Hawaiians

INTRODUCTION

American Indian and Alaskan Natives (AIAN) and Native Hawaiian and Pacific Islanders (NHPI) research is limited, particularly in postoperative surgical outcomes. This study analyzes disparities in AIAN and NHPI surgical complications across all surgical types and identifies factors that contribute to postoperative complications.

METHODS

This retrospective cohort study examined all surgeries from 2011 to 2020 in the National Surgical Quality Improvement Program, queried by race. Multivariable models analyzed the association of race and ethnicity and 30-day postoperative complication. Next, multivariable models were used to identify preoperative variables associated with postoperative complications, specifically in AIAN and NHPI patients. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated.

RESULTS

AIAN patients were associated with higher odds of postoperative complication (AOR: 1.008 [CI: 1.005-1.011], P < 0.001) compared to non-Hispanic white patients. The comorbidities that were of higher incidence in AIAN patients, which also adversely contributed to postoperative complication, included dependent functional status, diabetes, congestive heart failure (CHF), open wounds, preoperative weight loss, bleeding disorders, preoperative transfusion, sepsis, hypoalbuminemia, along with an active smoking status and ASA ≥3. In NHPI patients, dependent functional status, CHF, renal failure, preoperative transfusion, open wounds, and sepsis were of higher incidence and significantly contributed to postoperative complication.

CONCLUSIONS

Surgical outcome disparities exist particularly in AIAN patients. Identification of modifiable patient risk factors may benefit perioperative care for AIAN and NHPI patients, which are historically understudied racial groups.

Racial Disparities in General Surgery Outcomes

INTRODUCTION

While disparities in Black and Hispanic and Latino patients undergoing general surgeries are well described, most analyses leave out Asian, American Indian or Alaskan Native (AIAN), and native Hawaiian or Pacific Islander patients. This study identified general surgery outcomes for each racial group in the National Surgical Quality Improvement Program.

METHODS

National Surgical Quality Improvement Program was queried to identify all procedures conducted by a general surgeon from 2017 to 2020 (n = 2,664,197). Multivariable regression models were used to investigate the impact of race and ethnicity on 30-day mortality, readmission, reoperation, major and minor medical complications, and non-home discharge destinations. Adjusted odds ratios (AOR) and 95% confidence intervals were calculated.

RESULTS

Compared to non-Hispanic White patients, Black patients had higher odds of readmission and reoperation, and Hispanic and Latino patients had higher odds of major and minor complications. AIAN patients had higher odds of mortality (AOR: 1.003 (1.002-1.005), P < 0.001), major complication (AOR: 1.013 (1.006-1.020), P < 0.001), reoperation (AOR: 1.009, (1.005-1.013), P < 0.001), and non-home discharge destination (AOR: 1.006 (1.001-1.012), P = 0.025), while native Hawaiian or Pacific Islander patients had lower odds of readmission (AOR: 0.991 (0.983-0.999), P = 0.035) and non-home discharge destination (AOR: 0.983 (0.975-0.990), P < 0.001) compared to non-Hispanic White patients. Asian patients had lower odds of each adverse outcome.

CONCLUSIONS

Black, Hispanic and Latino, and AIAN patients are at higher odds for poor postoperative results than non-Hispanic White patients. AIANs had some of the highest odds of mortality, major complications, reoperation, and non-home discharge. Social health determinants and policy adjustments must be targeted to ensure optimal operative results for all patients.

Gastric Bypass Mortality Trends in Racial Cohorts: Are We Improving?

INTRODUCTION

Roux-en-Y gastric bypass (RYGB) continues to be safely performed in racial cohorts. However, studies continue to report differences in complications, with non-Hispanic black (NHB) patients having a higher rate of adverse outcomes, including mortality. It is unclear how these disparate outcomes have evolved over time. Our objective was to determine RYGB procedure and mortality trends in racial cohorts.

METHODS

Using the 2015 to 2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) database, we identified primary RYGB cases performed laparoscopically or robotically. Non-Hispanic white (NHW) and non-Hispanic black (NHB) patient cohorts were matched based on patient and surgical characteristics. Conditional logistic regression analysis was conducted on the matched pairs. Primary outcomes of interest included year-to-year all-cause and procedure-related mortality. Stata/MP 16.1 was utilized for analysis, and a p-value of < 0.05 and a 95% confidence interval that excluded 1 were considered significant.

RESULTS

A total of 148,829 RYGB cases in NHW (82.8%) and Black (17.2%) patients were analyzed. RYGB trends remain similar for NHB and NHW patients over 5 years. In matched cohorts, all-cause mortality (OR 2.23; 95% CI: 1.16-4.29), aggregate related readmission (OR 1.39; 95% CI: 1.27-1.51), related reintervention (OR 1.36; 95% CI: 1.19-1.56), and VTE (OR 1.86; 95% CI: 1.40-2.45) were more likely in NHB patients. During the study period, year-to-year mortality was higher in NHB patients compared to NHW patients.

CONCLUSION

Over a 5-year period, year-to-year mortality remains higher in NHB patients after RYGB. While bariatric outcomes continue to improve, outcome gaps between racial cohorts seem to persist.

Outcomes and Trends of Endoscopic Bariatric Therapies (EBT) Among Minority Populations

INTRODUCTION

Endoscopic bariatric therapies (EBT) have emerged as effective options for weight loss. While the benefits of EBT have been documented, data regarding such therapies among minority populations remains scant. We aim to investigate EBT trends and outcomes in minority populations.

METHODS

Data were extracted from the 2015 to 2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) databases. Intragastric balloon (IGB) and endoscopic sleeve gastroplasty (ESG) cases were identified, and procedure volume assessed by year and race/ethnicity. Measures of interest included year-to-year mortality, surgical complications, and 30-day adverse outcomes.

RESULTS

Of 966,646 cases in the MBSAQIP databases, 5209 (0.54%) IGB and ESG cases were included. 10.7% were black, and 81.6% were female patients. Compared to white patients, black and Hispanic patients were younger (p < 0.01) with a higher body mass index (p < 0.001). Mortality (0.03% vs. 0% vs. 0%, p = 0.99), reoperation (1.1% vs. 0.8% vs. 0.6%, p = 0.30), and reintervention (3.9% vs. 3.2% vs. 2.3%, p = 0.09) rates were similar between racial/ethnic cohorts. All complications were similar between racial/ethnic cohorts, except a higher rate of venous thromboembolism, in Hispanic (1.04%, p < 0.01) compared to black (0.18%) and white (0.21%) patients. IGB and ESG were predominantly performed in white and Hispanic patients, respectively. ESG was associated with a higher leak (0.6% vs. 0.02%, p < 0.01) and venous thromboembolism (VTE) (1.0% vs. 0.12%, p < 0.01) rate.

CONCLUSION

While EBTs have increased annually, they are performed less in black patients. Future studies are needed to identify access barriers for black patients. They are safely performed with similar outcomes in racial/ethnic cohorts, except for a higher VTE rate in Hispanic patients.

Racial disparity in causes for readmission following bariatric surgery

BACKGROUND

Readmission after bariatric surgery is not cost-effective and is a preventable quality metric within standardized practices. However, reasons for readmission among racial/ethnic bariatric cohorts are less explored and understood.

OBJECTIVE

Our study objective was designed to compare reasons for readmission among racial/ethnic cohorts of bariatric patients.

SETTING

Academic hospital.

METHODS

We performed a retrospective analysis of the 2015-2018 MBSAQIP databases to identify Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) cases. Regression analyses determined predictors of all-cause and bariatric-related readmissions. Reasons for readmission were compared between racial/ethnic cohorts using propensity score matching.

RESULTS

More than 550 000 RYGB and SG cases were analyzed. The readmission rate was 3%-4%. Black race, RYGB, robot-assisted approach, and numerous co-morbidities were independently associated with readmission (P <.05). In RYGB cases, black (versus white) patients were at decreased odds of leak-related (P < .001) and cardiovascular-related (P < .001) readmissions but at increased odds of readmissions related to renal complications (P < .001). Hispanic (versus white) patients had a higher likelihood of venous thromboembolism-related readmissions (P < .001). In SG cases, black (versus white) patients had a similar lower likelihood of readmission related to leaks or cardiovascular complications but higher odds of readmission related to renal complications (P < .001). Hispanic (versus black) patients had a higher likelihood of leak-related readmissions (P < .001).

CONCLUSION

Readmission reasons after bariatric surgery vary by race/ethnicity. Perioperative pathways to mitigate complications, including readmissions, should consider these disparate findings.

Racial disparities in complications and mortality after bariatric surgery: A systematic review

BACKGROUND

Studies have shown racial discrepancies in the rates of postoperative adverse events following bariatric surgery (BS). We aim to systematically review the literature examining racial disparities in postoperative adverse events.

METHODS

PubMed, Embase, and SCOPUS databases were searched for studies that reported race, postoperative adverse events and/or length of stay.

RESULTS

Thirty-five studies were included. Most compared Black and White patients using standardized databases. Racial/ethnic terminology varied. The majority found increased 30-day mortality and morbidity and length of stay in Black relative to White patients. Differences between White and Hipanic patients were mostly non-significant in these outcomes.

CONCLUSIONS

Black patients may experience higher rates of adverse events than White patients within 30 days following bariatric surgery. Given the limitations in the large multicenter databases, explanations for this disparity were limited. Future research would benefit from longer-term studies that include more races and ethnicities and consider socioeconomic factors.