Sex and Race Predict Adverse Outcomes Following Bariatric Surgery: an MBSAQIP Analysis.

Abstract

While bariatric surgery is safe, rates of postoperative complications continue to vary considerably across specific patient populations. We identified all Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry (MBSAQIP) patients who underwent primary laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) from 2015 to 2017. Categorical variables were expressed as percentages and continuous variables as weighted mean ± standard deviation (SD). Univariate analysis was performed using chi-squared tests for categorical data and independent sample t test for continuous data. Non-parsimonious multivariable logistic regression models were developed to determine predictive factors for mortality and major complications. A total of 430,936 patients were identified using the MBSAQIP database from 2015 to 2017 (Table 1). The majority of patients were female (79.3%), white (73.1%), and underwent laparoscopic sleeve gastrectomy (72.8%). The second most common identified race was African-American (17.6%) followed by other (9.3%). The mean age of our population was 43.9 ± 11.0years with a mean body mass index of 46.6 ± 8.5kg/m2 and a mean operative length of 89.7 ± 48.5min. Males were more likely to experience serious complications (3.7% vs. 3.45%; p = 0.002) and increased reoperation rates (1.33% vs. 1.18%; p < 0.001) and had a 2-fold greater mortality (0.18% vs. 0.07; p < 0.001) in comparison with female patients. Female patients had increased intervention rates (1.34% vs. 1.18%; p < 0.001) and readmission rates (3.89% vs. 3.53%; p < 0.001) at 30days. Black patients had higher rates of serious complications (4.14% vs. 3.41%; p < 0.001), mortality (0.13% vs. 0.09%; p < 0.001), intervention (1.74% vs. 1.24%; p < 0.001), and readmission (5.03% vs. 3.56%; p < 0.001) at 30days when compared with white patients. Female sex (OR 1.05; 95% CI 1.05-1.10; p < 0.001) and black race (OR 1.30; 95 % CI 1.24-1.35; p < 0.001) were independent predictors of major complications. Female sex was the single greatest protective factor for mortality following bariatric surgery (OR 0.53; 95% CI 0.42-0.65; p < 0.001) while black race was one of the greatest independent predictors of mortality (OR 1.78; 95% CI 1.39-2.26; p < 0.001). Race and sex are independent predictors of adverse outcomes following bariatric surgery in a multivariate logistic regression analysis of the MBSAQIP database. The influence of these factors requires further study in order to continue optimizing bariatric surgery outcomes.