Racial disparities in mortality in patients undergoing bariatric surgery in the U.S.A

Abstract

Background: Non-Hispanic blacks bear a disproportionate burden of the growing obesity epidemic. Bariatric surgery is an effective treatment for morbid obesity. We sought to assess for racial disparities in short-term outcomes following bariatric surgery.

Methods: Patients undergoing bariatric surgery were extracted from the Nationwide Inpatient Sample between 1999 and 2007. In-hospital mortality and length of stay were compared between different racial groups undergoing bariatric surgery after stratification by gender, and multivariate analysis was conducted to adjust for demographic, surgery year, and clinical and hospital characteristics.

Results: There were 115,507 bariatric surgeries. Overall mortality rate was 2.5 deaths per 1,000 and was higher among non-Hispanic blacks compared to non-Hispanic whites (3.7 vs. 2.3 per 1,000; P = 0.007). Racial mortality disparities were most pronounced among males and at hospitals with lowest surgical volumes. In multivariate analysis, predictors of mortality were non-Hispanic black race (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.22-2.45), increasing age, increasing Charlson index (OR, 1.26; 95% CI, 1.16-1.37), Medicare (OR, 2.13; 95% CI, 1.57-2.91), and Medicaid (OR, 3.35; 95% CI, 2.29-4.91) insurance. Incremental calendar year had reduced odds of mortality (OR, 0.80; 95% CI, 0.76-0.83). Above national median neighborhood income (OR, 0.59; 95% CI, 0.42-0.83) was protective in males, while teaching hospital status conveyed greater mortality (OR, 2.12; 95% CI, 1.40-3.22).

Conclusions: Non-Hispanic blacks undergoing bariatric surgery demonstrate higher in-hospital mortality than their racial counterparts. It is unclear if this disparity is due to susceptibility to obesity-related mortality or suboptimal delivery of healthcare in the perioperative setting.