Higher risk for hospitalization, mortality in Black, Hispanic patients after Roux-en-Y
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While both Roux-en-Y gastric bypass and sleeve gastrectomy resulted in weight loss and lower HbA1c across all racial and ethnic groups, Black and Hispanic patients who underwent gastric bypass experienced more postsurgical complications.
“Both observational studies and clinical trials over the last 10 years have shown that there is no other intervention that is as effective as metabolic and bariatric surgery for durable weight loss and comorbidity remission (eg, type 2 diabetes),” Karen J. Coleman, PhD, of the department of research and evaluation at Kaiser Permanente Southern California, and colleagues wrote in JAMA Surgery. “There is limited evidence, however, that racial and ethnic groups of patients may not benefit in the same way from metabolic and bariatric surgery.”
To compare the results of gastric bypass vs. sleeve gastrectomy across racial and ethnic groups, Coleman and colleagues performed a retrospective, observational, comparative effectiveness cohort study using data from the National Patient-Centered Clinical Research Network Bariatric Study. They included 36,871 patients, aged 12 to 79 years, who underwent primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between Jan. 1, 2005, and Sept. 30, 2015, at 25 participating health care systems.
According to researchers, the mean patient age was 45 years, 81% of patients were women, and 53% of patients self-identified as white, 24% Hispanic, 19% Black and 2% other. The race for 2% of patients was unrecorded. Study outcomes included percentage total weight loss; type 2 diabetes remission, relapse and change in HbA1c level; and safety and utilization outcomes (operations, endoscopy, hospitalizations, mortality, revisions/conversions, 30-day major adverse events) at 1, 3 and 5 years postoperatively.
For Black, white and Hispanic patients in all follow-up years, investigators reported greater weight loss and mean reductions in HbA1c with RYGB compared with SG. While the difference in 5-year weight loss by racial group ranged from –7.6% to –5.9% and the difference in change in HbA1c at 5 years ranged from –0.25% to –0.45%, “the magnitude of these differences was small among racial and ethnic groups,” researchers wrote.
However, Coleman and colleagues reported higher risk for hospitalization among Black patients who underwent RYGB vs. SG (HR = 1.45; 95% CI, 1.17-1.79), with similar results for Hispanic patients (HR = 1.48; 95% CI, 1.22-1.79). Moreover, Hispanic patients who underwent RYGB experienced greater risk for all-cause mortality (HR = 2.41; 95% CI, 1.24-4.7) and nearly twice the odds of 30-day major adverse events.
Investigators reported no link between race and type of weight loss operation regarding diabetes relapse and remission.
“There could be several reasons why Black and especially Hispanic patients had higher rates of complications with RYGB than SG,” the researchers wrote. “Given that there are higher risks with RYGB generally, the findings for Black and Hispanic patients could be exacerbated by poor access to or coverage for postoperative health care.
In addition, there are many other health system and societal factors shown to determine racial and ethnic disparities in health outcomes generally, such as the number of racial and language concordant physicians available to patients, structural racism and discrimination during clinical care encounters and immigration status.”
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