There are clinically and statistically significant differences in safety and utilisation outcomes for Black and Hispanic patients who had Roux-en-Y gastric bypass (RYGB) compared with sleeve gastrectomy (SG), according to US researchers. The findings were featured in the paper, ‘Comparative Safety and Effectiveness of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy for Weight Loss and Type 2 Diabetes Across Race and Ethnicity in the PCORnet Bariatric Study Cohort’, published in JAMA Surgery.
Bariatric surgery is known the be the most effective treatment for severe obesity. However, it is unclear whether the long-term safety and comparative effectiveness of these operations differ across racial and ethnic groups. Therefore, researchers compared the outcomes of RYGB and SG across racial and ethnic groups in the National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study.
The PCORnet Bariatric Study is a retrospective, observational, comparative effectiveness cohort study that comprised 25 health care systems. Patients were adults and adolescents aged 12 to 79 years who underwent a primary (first nonrevisional) RYGB or SG operation between January 2005, and September 2015, at participating health systems. Patient race and ethnicity included Black, Hispanic, White, other and unrecorded.
The researchers recorded the percentage total weight loss (%TWL); T2DM remission, relapse and change in haemoglobin A1c (HbA1c) level; and postsurgical safety and utilisation outcomes (operations, interventions, revisions/conversions, endoscopy, hospitalizations, mortality, 30-day major adverse events) at one-, three and five years post-surgery.
Results
A total of 36,871 patients (29,746 female patients [81%]) were included in the weight analysis. Patients identified with the following race and ethnic categories:
6,891 Black (19%)
8,756 Hispanic (24%)
19,645 White (53%)
826 other (2%) and;
783 unrecorded (2%)
Weight loss and mean reductions in HbA1c level were larger for RYGB than SG in all years for Black, Hispanic and White patients (difference in five-year weight loss: Black, −7.6%; 95% CI, −8.0 to −7.1; p<0.001; Hispanic, −6.2%; 95% CI, −6.6 to −5.9; p<0.001; White, −5.9%; 95% CI, −6.3 to −5.7; p<0.001; difference in change in year 5 HbA1c level: Black, −0.29; 95% CI, −0.51 to −0.08; p=0.009; Hispanic, −0.45; 95% CI, −0.61 to −0.29; p<0.001; and White, −0.25; 95% CI, −0.40 to −0.11; p=0.001).
These differences were small among racial and ethnic groups (1%-3% of %TWL). Black and Hispanic patients had higher risk of hospitalisation when they had RYGB compared with SG (p=0.001 and p<0.001, respectively). Hispanic patients had greater risk of all-cause mortality (p=0.01) and higher odds of a 30-day major adverse event (p<0.001) for RYGB compared with SG. There was no interaction between race and ethnicity and operation type for diabetes remission and relapse.
The researcher noted that these differences may be associated with the preoperative preparation and postoperative care processes for these patients rather than the bariatric operations themselves; work should focus on how to improve care processes and decision-making between bariatric operations for diverse patient populations.
“Variability of the comparative effectiveness of operations for %TWL and HbA1c level across race and ethnicity was clinically small; however, differences in safety and utilization outcomes were clinically and statistically significant for Black and Hispanic patients who had RYGB compared with SG,” the authors concluded. “These findings can inform shared decision-making regarding bariatric operation choice for different racial and ethnic groups of patients.”