Racial disparities in bariatric surgery postoperative weight loss and co-morbidity resolution: a systematic review |
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| Institution: | 1. Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California;2. Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California;3. Karsh Division of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Los Angeles, California;1. University of Ottawa, Department of Medicine, Ottawa, Ontario, Canada;2. Queen’s University, Department of Public Health Sciences, Kingston, Ontario, Canada;3. Queen’s University, Department of Surgery, Kingston, Ontario, Canada;4. McMaster University, Hamilton, Ontario, Canada;1. Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, Rhode Island;2. Department of Surgery, The Miriam Hospital/Brown Alpert Medical School, Providence, Rhode Island;3. Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts;1. Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts;2. Department of Medicine - Division of Endocrinology-Neuroendocrine, Department of Pediatrics - Division of Endocrinology, Massachusetts General Hospital, Boston, Massachusetts;3. Department of Surgery, New York-Presbyterian Morgan Stanley Children''s Hospital, New York, New York;4. Department of Surgery, Lucille Packard Children’s Hospital, Palo Alto, California;5. Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, Massachusetts;6. Department of Surgery, MassGeneral Hospital for Children, Boston, Massachusetts;1. Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania;2. Department of Clinical Sciences, Division of Biostatistics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania;3. Department of Surgery, Division of General Surgery, Mayo Clinic, Jacksonville, Florida;1. Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania;2. Department of Surgery—Division of Minimally Invasive Surgery, Penn State Health, Hershey, Pennsylvania;1. Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina;2. Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina |
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| Abstract: | While bariatric surgery is an accepted treatment for morbid obesity, the impact of race on surgical outcomes remains unclear. This systematic review aims to compare differences in weight loss and co-morbidity outcomes among various races after bariatric surgery. PubMed, Medline, and SCOPUS databases were queried to identify publications that included more than 1 racial group and reported weight loss outcomes after bariatric surgery. A total of 52 studies were included. Non-Hispanic black (NHB) patients comprised between 5.5% and 69.7% and Hispanic patients comprised between 4.7% and 65.3% of the studies’ populations. Definitions of weight loss success differed widely across studies, with percent excess weight loss being the most commonly reported outcome, followed by percent total weight loss and change in body mass index (BMI). Statistical analyses also varied, with most studies adjusting for age, sex, preoperative weight, or BMI. Some studies also adjusted for preoperative co-morbidities, including diabetes mellitus, hypertension, and hyperlipidemia, or socioeconomic status, including income, education, and neighborhood poverty. The majority of studies found less favorable weight loss in NHB compared to Hispanic and non-Hispanic white (NHW), patients while generally no difference was found between Hispanic and NHW patients. The trend also indicates no association between race and resolution of obesity-related co-morbidities. Racial minorities lose less weight than NHW patients after bariatric surgery, although the factors associated with this discrepancy are unclear. The heterogeneity in reporting weight loss success and statistical analyses amongst the literature makes an estimation of effect size difficult. Generally, racial disparity was not seen when examining co-morbidity resolution after surgery. More prospective, robust, long-term studies are needed to understand the impacts of race on bariatric surgery outcomes and ensure successful outcomes for all patients, regardless of race. |
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| Keywords: | Race Racial disparity Bariatric surgery Weight loss Co-morbidity resolution |
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