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CC BY 4.0 · Surg J (N Y) 2021; 07(03): e147-e153
DOI: 10.1055/s-0041-1734030
Original Article

The Effect of Social Determinants and Socioeconomic Status on Laparoscopic Roux-En-Y Gastric Bypass for Weight Loss: An Analysis of the National Inpatient Sample

Supreet Singh
1   Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
,
Jarot J. Guerra
1   Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
,
Paige Lazar
1   Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
,
Aziz M. Merchant
1   Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
› Author Affiliations Funding None.
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Abstract

Objective In the United States, Black and Hispanic patients have a higher prevalence of obesity than Whites (49.6 vs. 44.8 vs. 42.2%, respectively). Despite higher rates of obesity among minority populations, bariatric surgery is performed at higher obesity levels in minorities than in Whites. This study examines the effects of various socioeconomic factors such as race, payer type, and income on the likelihood of undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) at class II versus class III obesity and their associated complications.

Materials and Methods National Inpatient Sample (NIS) from 2016 to 2017 was queried to identify patients at least 18 years of age with a concomitant diagnosis of class II or class III obesity who underwent LRYGB. We analyzed obesity level at the time of LRYGB (class II vs. class III), postoperative intestinal obstruction during the admission, and occurrence of any noninfectious complication related to the surgery as our main outcomes. A multivariate logistic regression model was utilized to assess the association between our outcomes and socioeconomic factors associated with the admission.

Results A total of 76,405 LRYGB operations were included. Out of this total, 83% (63,640) LRYGB operations were in class III obesity. Black patients had a lower rate (11.6%) of LRYGB procedures at class II obesity than White (17.6%) and Hispanic (18%) patients (p < 0.001). Medicare, Medicaid, and lower income quartiles also showed lower rates of operation at class II obesity (p < 0.001). Black patients were 29% (95% confidence interval [CI]: 0.61–0.83, p < 0.001) less likely than Whites to have a LRYGB procedure at class II obesity, they were 119% (95% CI: 1.17–4.11, p = 0.0014) more likely to suffer a postoperative intestinal obstruction, and they were 93% (95% CI: 1.31–2.84, p < 0.001) more likely to suffer a noninfectious complication.

Conclusion Socioeconomic disparities in the surgical management of severe obesity persist in the United States, especially for LRYGB. This study highlights multiple demographic factors that led to LRYGB at later obesity levels. Black patients were also more likely to be associated with postoperative complications during the admission. The determinants of health disparities in obese patients need to be examined further to reduce potential long-term morbidity and mortality in minorities. Further research is also required to identify the adverse effects of health disparities in patients with severe obesity and obesity-related comorbidities.

Keywords

bariatric surgery - surgical outcomes - health services research - obesity treatment - health disparities - laparoscopic Roux-en-Y gastric bypass

Authors' Contributions

All authors listed above contributed to the manuscript equally and have met all the authorship guidelines as per the International Committee of Medical Journal Editors.


Supplementary Material



Publication History

Received: 24 March 2020

Accepted: 08 March 2021

Article published online:
19 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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