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

While bariatric surgery is safe, rates of postoperative complications continue to vary considerably across specific patient populations.

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 ± 11.0 years with a mean body mass index of 46.6 ± 8.5 kg/m² and a mean operative length of 89.7 ± 48.5 min. 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 30 days. 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 30 days 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.