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Roux-en-Y Gastric Bypass (RYGB) has been associated with increased weight loss but more complications when compared with sleeve gastrectomy (SG). However, a direct comparison between RYGB and SG has never been performed in patients with a history of solid organ transplantation. The aim of this study was to determine the association between procedure type and surgical outcomes.Patients with a history of solid organ transplantation were identified in the Metabolic and Bariatric Surgery Accreditation Quality Improvement Project Participant Use File database from 2017 to 2018. Procedure type (SG versus RYGB) was used to stratify patients. Propensity score matching and multivariable logistic regressions were used, and outcomes were compared.Of 678 cases identified, 80% (n = 542) underwent an SG and 20% (n = 136) had an RYGB. Patients differed significantly (P 0.05) by multiple demographic variables. Multivariable regression revealed RYGB to be associated with higher overall morbidity (odds ratio [OR] 1.98; P = 0.012), morbidity related to surgery (OR 2.47; P = 0.002), unplanned readmissions (OR 2.48; P = 0.002), and readmissions related to surgery (OR 2.32; P = 0.016). After propensity score matching, RYGB, compared with SG, was also associated with higher morbidity (14% versus 7.4%; P = 0.077) and readmissions (13% versus 6.6%; P = 0.099) related to surgery, although this did not reach statistical significance.In patients with a history of solid organ transplant, RYGB was associated with increased morbidity and readmissions compared with SG.

Background Bariatric surgery outcomes in elderly patients have been shown to be safe, but with a higher rate of adverse outcomes compared with nonelderly patients. The impact of race on bariatric surgery outcomes continues to be explored, with recent studies showing higher rates of adverse outcomes in black patients. Perioperative outcomes in racial cohorts of elderly bariatric patients are largely unexplored. Objective The goal of this study was to compare outcomes between elderly non-Hispanic black (NHB) and non-Hispanic white (NHW) bariatric surgery patients to determine whether outcomes are mediated by race. Setting Academic hospital. Methods Patients who had a primary Roux-en-Y (RYGB) and sleeve gastrectomy (SG) in the period 2015-2018 and were at least 65 years of age were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Data File (MBSAQIP PUF). Selected cases were stratified by race. Outcomes were compared between matched racial cohorts. Multivariate regression analyses were performed to determine whether race independently predicted morbidity. Results From 2015 to 2018, 29,394 elderly NHW (90.8%) and NHB (9.2%) patients underwent an RYGB or SG. At baseline, NHB elderly patients had a higher burden of co-morbid conditions, resulting in higher rates of overall (7.7% versus 6.4%, P = .009) and bariatric-related (5.4% versus 4.1%, P = .001) morbidity. All outcome measures were similar between propensity-score-matched racial elderly bariatric patient cohorts. On regression analysis, NHB race remained independently correlated with morbidity (odds ratio [OR] 1.3, 95% CI 1.08-1.47, P = .003). Conclusion RYGB and SG are safe in elderly patient cohorts, with no differences in adverse outcomes between NHB and NHW patients, accounting for confounding factors. While race does not appear to impact outcomes in the elderly cohorts, NHB race may play a role in access.

Chronic kidney disease (CKD) independently increases the risk of 30-day adverse outcomes following metabolic and bariatric surgery (MBS). However, no studies have evaluated the stage of CKD at which increased perioperative risk is manifested. Here, we correlate 30-day major morbidities after MBS with extent of renal disease based on CKD Stage.To determine the impact of CKD stage on perioperative outcomes after bariatric surgery.Academic Hospital.From the 2017 Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) database, we identified patients with CKD who underwent sleeve gastrectomy or laparoscopic gastric bypass surgery. Glomerular filtration rates (GFRs) were calculated and cohorts were generated based on CKD Stage. Complication rates and rates of morbidity and mortality were compared between stages, and strengths of correlation were calculated.GFR and CKD Stage were calculated for 150,283 patients. There was a significant increase in the risk of major morbidity at each progressive stage of CKD (P.001 for all compared stages). There was a strong positive linear correlation between increasing CKD Stage and total morbidity (rAn increased risk of perioperative complications may be seen in early stages of CKD, and risk is compounded in more advanced stages. Bariatric surgical candidates should be counseled on their increased risk of surgical complications even with mild CKD, and the benefits of bariatric surgery should be carefully weighed against significantly increased risks of complications in severe CKD.

Introduction Bariatric surgery is associated with 20–30% weight recidivism. As a result, revisional bariatric operation is increasingly performed. Disparity in bariatric outcomes remains controversial and very little is known about revisional bariatric surgery outcomes in ethnic cohorts. Methods Revisional bariatric cases were identified from the 2015 and 2016 Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Data File. 1:1 case-control matching was performed and perioperative outcomes compared between racial cohorts. Results 24,197 cases were analyzed, including 20.78% Black patients. At baseline, there were differences in demographics and pre-existing conditions between racial cohorts. Matched analysis compared 7,286 Black and White patients. Operative duration (p = 0.008) and length of stay (p = 0.0003) were longer in Black patients. Readmission (6.8% vs. 5.4%, p = 0.009) was higher in Black patients. Bleeding (0.82% vs. 0.38%, p = 0.02) and surgical site infection (SSI) (2.6% vs. 1.8%, p = 0.01) were higher in White patients. Conclusion Revisional bariatric surgery is safe. Apart from a higher rate of bleeding, SSI and readmission, outcomes were not mediated by race.

Background Prophylactic inferior vena cava (IVC) filter use in bariatric surgery patients is a physician- and patient-dependent practice pattern with unclear safety and efficacy. Factors that mediate physicians’ decisions for IVC filter placement preoperatively remain unclear. The role of race in decision-making also remains unclear. Methods From the 2015–2016 MBASQIP database, patient characteristics leading to IVC filter use and outcomes after IVC filter placement were compared between Black and White primary bariatric surgery patients. Results Prophylactic IVC filter was used in 0.66% of Black and White patients. IVC filter use was three-fold higher in Black patients, despite this cohort having a lower venous thromboembolism (VTE) risk profile than White counterparts. Black race was an independent predictor for IVC filter placement on multivariate analysis. After receiving an IVC filter, Black patients had higher rates of 30-day adverse outcomes. Conclusions In this study, Black race was independently associated with the likelihood of receiving a prophylactic IVC filter, despite lower rates of VTE risk factors and lack of recommendations for its use. Further research is needed to explore why this disparity in clinical practice exists.

The rate of robotic-assisted metabolic and bariatric surgery (MBS) is increasing. While discord remains about racial disparity in primary MBS, there are no data on robotic MBS outcomes in racial cohorts.To determine whether outcomes following robotic-assisted Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are mediated by race or ethnicity.University Hospital, United States.Robotic RYGB and SG cases were identified from the 2015-2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) databases using Current Procedure Terminology codes 43644, 43645, and 43775. Selected cases were stratified by race and ethnicity. Case-control matched and logistic regression analyses were performed.Matched analyses compared outcomes in 2666 RYGB cases of Black versus White patients and 1794 RYGB cases of Hispanic versus White patients. Black RYGB patients had longer operative lengths (OLs; P = .0008) and postoperative lengths of stay (P = .001), and a higher rate of pulmonary embolism (P = .05). Hispanic (versus White) RYGB patients had longer lengths of stay (P = .007). All other outcomes were similar between RYGB racial and ethnic cohorts. Matched analyses also compared outcomes of 8328 SG cases in Black versus White patients and 4852 SG cases in Hispanic versus White patients. Black patients had longer OLs (P = .004), had longer lengths of stay (P.0001), had higher overall morbidity (P = .02), had higher bariatric-related morbidity (P = .02), had higher rates of readmission (P = .009), and were more likely to have an operative drain present at 30 days (P = .001). All other outcome measures were similar between racial/ethnic SG cohorts.Robotic-assisted SG is associated with higher overall and bariatric-related morbidity, but not mortality. However, robotic-assisted RYGB and SG remain safe, with lower rates of mortality and morbidity.

Background Robotic-assisted metabolic and bariatric surgery (MBS) is being performed with increased frequency in the United States, including for revisional MBS. However, little is known about perioperative outcomes between racial and ethnic cohorts after revisional robotic-assisted MBS. Objective The goal of our study was to determine if there are racial differences in outcomes after robotic-assisted revisional MBS. Setting University Hospital, United States. Methods Using the 2015–2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, we identified patients undergoing revisional MBS by a robotic-assisted approach. Univariate analyses were performed of unmatched and matched racial and ethnic cohorts, comparing black versus white patients and Hispanic versus white patients. Results Of 2027 robotic-assisted revisional MBS cases in the database, 1922 were included in our analysis, including 67%, 22.6%, and 10.4% white, black, and Hispanic patients, respectively. At baseline, there were some differences in patient characteristics between racial and ethnic cohorts. After propensity matching, outcomes between black and white patients were similar, except for higher rates of superficial surgical site infection among white patients (P = .05) and higher rates of organ space surgical site infection in black patients (P = .05). Outcomes were also similar between matched white and Hispanic patients, except for a higher bleeding in white patients (2% versus 0%, P = .04). There were no mortality or morbidity differences between racial and ethnic cohorts. Conclusion Morbidity and mortality after robotic-assisted revisional MBS do not seem to be mediated by race or ethnicity.

Background Type 2 diabetes (T2D) is frequently present in Metabolic and Bariatric Surgery (MBS) patients and is associated with increased morbidity and mortality. Organ transplantation patients also suffer from severe obesity and are now increasingly undergoing MBS. Objective To determine the association of T2D and perioperative outcomes after MBS in previous solid organ transplantation patients Setting University Hospital, United States. Methods Patients with a history of solid organ transplantation undergoing sleeve gastrectomy and Roux-en-Y gastric bypass were identified from the 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Patients were then stratified by a history of T2D. Propensity-score matching was performed between the 2 cohorts. Outcomes were compared by Mann-Whitney U, Χ2, and multivariable logistic regression analysis for overall and morbidity related to MBS. Results Before matching 338 patients with a prior history of solid organ transplantation were identified including 132 (39%) with and 206 (61%) without diabetes. There were no significant differences in outcomes between the 2 cohorts at baseline, but these patients were significantly different at baseline. After matching, 85 patients with and without T2D were identified. Overall and morbidity related to MBS were similar (P > .5). Furthermore, multivariable logistic regression revealed T2D to not have an increased risk for overall (odds ratio .95, P = .09) or morbidity related to MBS (odds ratio .92, P = .87). Conclusion MBS in T2D patients with previous solid organ transplantation is overall safe with low rates of morbidity and mortality. Diabetes was not an independent predictor of adverse outcomes in this cohort of patients. Larger cohort studies are needed.

Metabolic and bariatric surgery remains a safe and effective treatment for severe obesity. Ethnic minorities are disproportionately affected by obesity but are less likely to undergo metabolic and bariatric surgery. There remains controversy about outcomes among black patients compared with other ethnic groups after bariatric surgery.The purpose of this case-control matched study using the largest clinically available bariatric data was to determine if there is racial disparity in perioperative outcomes after primary bariatric surgery.University Hospital, United States.Patients who had a primary Roux-en-Y gastric bypass or sleeve gastrectomy in 2015 to 2016 were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Case controlled-matched analyses were performed.We compared 80,238 equally matched nonHispanic black and white patients. Operative length and hospital stay were longer in black patients. All-cause mortality was 2-fold higher in black patients (P = .003). Black patients had significantly higher rates of 30-day readmission and reintervention (P.0001), pulmonary embolism (P =.0004), and aggregate renal (P = .01) and venous thromboembolic (P = .001) complications. Postoperative myocardial infarction, cardiac arrest, pulmonary embolism, and all-cause mortality were significant higher in black patients after sleeve gastrectomy, but not Roux-en-Y gastric bypass.In this study, pulmonary embolism and mortality were significantly higher in black patients after sleeve gastrectomy. Further studies are needed to determine causality.