Department of Surgery, Harper University Hospital and Wayne State University, Detroit, Michigan.
Department of Surgery, Henry Ford Health System, Detroit, Michigan.
JAMA Surg. 2019 May 1;154(5):e190029. doi: 10.1001/jamasurg.2019.0029. Epub 2019 May 15.
The outcomes of bariatric surgery vary considerably across patients, but the association of race with these measures remains unclear.
To examine the association of race on perioperative and 1-year outcomes of bariatric surgery.
DESIGN, SETTING, AND PARTICIPANTS: Propensity score matching was used to assemble cohorts of black and white patients from the Michigan Bariatric Surgery Collaborative who underwent a primary bariatric operation (Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding) between June 2006 and January 2017. Cohorts were balanced on baseline characteristics and procedure. Conditional fixed-effects models were used to evaluate the association of race on outcomes within hospitals and surgeons. Data analysis occurred from June 2006 through August 2018.
Thirty-day complications and health care resource utilization measures, as well as 1-year weight loss, comorbidity remission, quality of life, and satisfaction.
In each group, 7105 patients were included. Black patients had a higher rate of any complication (628 [8.8%] vs 481 [6.8%]; adjusted odds ratio, 1.33 [95% CI, 1.17-1.51]; P = .02), but there were no significant differences in the rates of serious complications (178 [2.5%] vs 135 [1.9%]; adjusted odds ratio, 1.32 [95% CI, 1.05-1.66]; P = .29) or mortality (5 [0.10%] vs 7 [0.10%]; adjusted odds ratio, 0.73 [95% CI, 0.23-2.31]; P = .54). Black patients had a greater length of stay (mean [SD], 2.2 [3.0] days vs 1.9 [1.7] days; adjusted odds ratio, 0.30 [95% CI, 0.20-0.40]; P < .001), as well as a higher rate of emergency department visits (541 [11.6%] vs 826 [7.6%]; adjusted odds ratio, 1.60 [95% CI, 1.43-1.79]; P < .001) and readmissions (414 [5.8%] vs 245 [3.5%]; adjusted odds ratio, 1.73 [95% CI, 1.47-2.03]; P < .001). At 1 year, black patients had lower mean total body weight loss and as a percentage of weight (32.0 kg [26%]; vs 38.3 kg [29%]; P < .001) and this held true across procedures. Remission of hypertension was lower for black patients (564 [40.0%] vs 1096 [56.0%]; P < .001), but the rate of sleep apnea remission (467 [62.6%] vs 615 [56.1%]; P = .005) and gastroesophageal reflux disease (309 [78.6%] vs 453 [75.4%]; P = .049) were higher. There were no significant differences in remission of diabetes with insulin dependence, diabetes without insulin dependence,or hyperlipidemia hyperlipidemia. Fewer black patients than white patients reported a good or very good quality of life (1379 [87.2%] vs 2133 [90.4%]; P = .002) and being very satisfied with surgery (1908 [78.4%] vs 2895 [84.2%]; P < .001) at 1 year.
Black patients undergoing bariatric surgery in Michigan had significantly higher rates of 30-day complications and resource utilization and experienced lower weight loss at 1 year than a matched cohort of white patients. While sleep apnea and gastroesophageal reflux disease remission were higher and hypertension remission lower in black patients, comorbidity remission was otherwise similar between matched cohorts. Racial and cultural differences among patients should be considered when designing strategies to optimize outcomes with bariatric surgery.
重要性：尽管减重手术的结果在不同患者中差异很大，但种族与这些结果的关系仍不清楚。
目的：研究种族对减重手术围手术期和 1 年结果的影响。
设计、地点和参与者：使用倾向评分匹配方法，从密歇根减重手术协作组中组建了接受主要减重手术（胃旁路手术、袖状胃切除术或可调胃束带术）的黑人和白人患者队列，这些手术于 2006 年 6 月至 2017 年 1 月期间进行。队列在基线特征和手术方式上进行平衡。采用条件固定效应模型评估医院和外科医生内种族对结果的影响。数据分析于 2006 年 6 月至 2018 年 8 月进行。
主要结局和测量指标：30 天并发症和医疗资源利用指标，以及 1 年体重减轻、合并症缓解、生活质量和满意度。
结果：在每个组中，都纳入了 7105 名患者。黑人患者的任何并发症发生率更高（628 例[8.8%]比 481 例[6.8%]；调整后的优势比，1.33[95%CI，1.17-1.51]；P=0.02），但严重并发症发生率（178 例[2.5%]比 135 例[1.9%]；调整后的优势比，1.32[95%CI，1.05-1.66]；P=0.29）或死亡率（5 例[0.10%]比 7 例[0.10%]；调整后的优势比，0.73[95%CI，0.23-2.31]；P=0.54）均无显著差异。黑人患者的住院时间更长（平均[标准差]，2.2[3.0]天比 1.9[1.7]天；调整后的优势比，0.30[95%CI，0.20-0.40]；P<0.001），急诊就诊率（541 例[11.6%]比 826 例[7.6%]；调整后的优势比，1.60[95%CI，1.43-1.79]；P<0.001）和再入院率（414 例[5.8%]比 245 例[3.5%]；调整后的优势比，1.73[95%CI，1.47-2.03]；P<0.001）也更高。在 1 年时，黑人患者的总体体重减轻量和体重减轻百分比均较低（32.0 千克[26%]；比 38.3 千克[29%]；P<0.001），这在所有手术中均成立。黑人患者的高血压缓解率较低（564 例[40.0%]比 1096 例[56.0%]；P<0.001），但睡眠呼吸暂停缓解率（467 例[62.6%]比 615 例[56.1%]；P=0.005）和胃食管反流病缓解率（309 例[78.6%]比 453 例[75.4%]；P=0.049）较高。胰岛素依赖型糖尿病、非胰岛素依赖型糖尿病或高脂血症的缓解率在两组间无显著差异。与白人患者相比，较少的黑人患者报告生活质量良好或非常好（1379 例[87.2%]比 2133 例[90.4%]；P=0.002），对手术非常满意（1908 例[78.4%]比 2895 例[84.2%]；P<0.001）。
结论和相关性：在密歇根州接受减重手术的黑人患者在 30 天并发症和资源利用方面的发生率明显更高，并且在 1 年时体重减轻量低于白人患者的匹配队列。尽管黑人患者的睡眠呼吸暂停和胃食管反流病缓解率较高，高血压缓解率较低，但两组间的合并症缓解率相似。在设计旨在优化减重手术结果的策略时，应考虑患者的种族和文化差异。
