Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California.
Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California.
Surg Obes Relat Dis. 2021 Oct;17(10):1799-1823. doi: 10.1016/j.soard.2021.06.001. Epub 2021 Jun 15.
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.
虽然减重手术是治疗病态肥胖的一种公认方法,但种族对手术结果的影响仍不清楚。本系统评价旨在比较不同种族在减重手术后体重减轻和合并症结果方面的差异。检索 PubMed、Medline 和 SCOPUS 数据库,以确定纳入超过 1 个种族群体并报告减重手术后体重减轻结果的出版物。共纳入 52 项研究。非西班牙裔黑人(NHB)患者占研究人群的 5.5%至 69.7%,西班牙裔患者占 4.7%至 65.3%。体重减轻成功的定义在不同的研究中差异很大,其中体重减轻的百分比超过是最常报告的结果,其次是体重总减轻的百分比和身体质量指数(BMI)的变化。统计分析也各不相同,大多数研究调整了年龄、性别、术前体重或 BMI。一些研究还调整了术前合并症,包括糖尿病、高血压和高脂血症,或社会经济状况,包括收入、教育和社区贫困。大多数研究发现,与西班牙裔和非西班牙裔白人(NHW)患者相比,NHB 患者的体重减轻效果较差,而西班牙裔和 NHW 患者之间一般没有差异。这一趋势也表明,种族与肥胖相关合并症的解决之间没有关联。在接受减重手术后,少数族裔比 NHW 患者体重减轻得少,尽管导致这种差异的因素尚不清楚。文献中报告的体重减轻成功和统计分析的异质性使得估计效应大小变得困难。一般来说,在检查手术后合并症的解决情况时,没有发现种族差异。需要更多前瞻性、稳健、长期的研究来了解种族对减重手术结果的影响,并确保所有患者(无论种族如何)都能取得成功。