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African Americans have worse outcomes from RYGB and SG

Tue, 07/07/2020 - 16:57
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African American (AA) patients undergoing bariatric surgery are younger and heavier than non-AA patients, present with different comorbidity profiles and exhibit worse outcomes following Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) than non-AA patients, including increased mortality rates in AA-SG patients.

The study, ‘Outcomes of Bariatric Surgery in African Americans: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Data Registry’, published in Obesity Surgery, compared outcomes for AA patients undergoing RYGB or SG with non-AA patients. The study researchers, from Carolinas Medical Center, Atrium Health, Charlotte, NC, used data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database to determine the proportion of AA versus non-AA patients undergoing bariatric surgery, analyse the relative differences between pre-operative co-morbidities based on the surgical procedure performed and to determine whether disparities in outcomes between these groups exists using propensity matched patient populations.

The primary outcomes were intra-operative outcomes, post-operative complications, and 30-day mortality, secondary outcomes included patient discharge destination, re-admission, re-intervention, and re-operation.

In total, 429,714 case were included in the analysis - 75,409 (17.55%) were AA and 354,305 (82.45%) non-AA patients, with 21.78% AA patients having a RYGB (versus 28.57% non-AA) and 78.22% underwent a SG procedure (versus 71.43% non-AA). AA patients were younger, more likely to be female, had a higher BMI at time of surgery, presented with fewer comorbidities than non-AA patients with the exception of hypertension, history of pulmonary embolism, inferior vena cava (IVC) filter, chronic steroid use and renal insufficiency/dialysis.

Operative times were longer for AA patients and AA patients were less likely to have a drain placed. Post-operatively, AA patients exhibited increased risk of major complications concomitant with decreased rates of minor complications and this was reflected in the incidence of the specific post-operative comorbidities.

RYGB

An analyses of procedure type, found that AA patients undergoing RYGB were younger, had higher mean BMIs and included more females than males compared with non-AA patients, and in an examination of matched data sets, only pre-operative BMI remained significantly different (48.41 ± 9.05 versus 48.05 ± 8.83). When using unmatched patient data sets, AA patients exhibited notably different comorbidity profiles compared with non-AA, with AA patients being more likely to have hypertension, renal insufficiency, diabetes (insulin and non-insulin-dependent), require a mobility device, require dialysis, have a history of PE, and have an IVC filter.

Operative duration, incidence of drain placement and conversion to open surgery were higher in AA-RYGB compared with non-AA-RYGB patients, and these differences remained when compared with matched patient data sets. Thirty- day mortality rates were higher in AA-RYGB patients when analysing unmatched data, but these differences were no longer evident when analysing matched data. African American patients were more likely to experience major complications than non-AA patients, and after matching, AA-RYGB patients had longer operative times, higher major complications, as well as 30-day re-admission, re-intervention, reoperation rates and discharge to place other than home, compared with non-AA patients.

SG

For patients who underwent SG, AA-SG patients were younger, had higher mean BMIs and included more females than males compared with non-AA patients, a subset analysis of unmatched SG patient data found. AA-SG patients had overall fewer co-morbidities when compared with non-AA-SG patients, with non-AA-SG patients having higher rate of GERD, prior PTC, prior cardiac surgery, history of MI, hyperlipidaemia, venous stasis, anticoagulation, prior foregut surgery, smoking, COPD, oxygen dependence, and sleep apnoea. AA-SG patients did have higher rates of hypertension, renal insufficiency, history of PE, dialysis, as well as presence of IVC filter.

However, many of the initial differences in pre-operative comorbidities between AA and non-AA patients undergoing SG were no longer evidenced when the analyses were performed using matched data, except prior history of cardiac surgery/MI, which were higher in the AA cohort compared with the matched non-AA cohort, and incidence of dialysis and history of IVC filter placement which were also higher in AA-SG patients.

AA-SG patients had longer operative times, higher incidence of major complications, including cardiac arrest, RI, PE, unplanned intubation, DVT, 30-day ICU admission, 30-day re-intervention and 30-day mortality. AA-SG patients also demonstrated higher 30-day readmission, dehydration, and destination other than home, compared with non-AA-SG patients.

“Close review of the specifics of these findings suggests care should be taken in interpreting data as it pertains to statistical differences relative to clinical significance,” the authors concluded. “Nevertheless, when using matched patient data, it is of note that we identify AA patients continue to exhibit worse outcomes, including higher rates of major complications in both RYGB and SG patient subsets, and higher mortality in SG patients compared with non-AA patients.”

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