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Black-versus-White racial disparities in 30-day outcomes at Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program–accredited centers: a needed quality indicator

Published:December 23, 2022DOI:https://doi.org/10.1016/j.soard.2022.12.031

      Abstract

      Background

      Creating a metric in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to assess Black-versus-White disparities is critical if we are to ensure equitable care for all.

      Objective

      To investigate Black-versus-White disparities while replicating MBSAQIP methodology with regard to covariates and modeling so that the results can serve as the foundation to create a benchmarked site-level Disparities Metric for MBSAQIP.

      Setting

      United States and Canada.

      Methods

      Across the 2015–2019 MBSAQIP cohorts, 543,976 adults underwent primary or revision sleeve gastrectomy or Roux-en-Y gastric bypass and were reported as either White or Black. Using a set of covariates derived from published MBSAQIP performance models, we performed multivariable logistic modeling with 10-fold cross-validation for the 11 outcomes evaluated in MBSAQIP Semiannual Reports, plus venous thromboembolism (VTE) and death. We analyzed primary and revision cases separately.

      Results

      After risk adjustment, Black patients experienced higher odds of all-occurrence morbidity (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.19–1.25; P < .001), serious events (OR, 1.08; 95% CI, 1.04–1.13; P < .001), all-cause intervention (OR, 1.31; 95% CI, 1.24–1.37; P < .001), related intervention (OR, 1.29; 95% CI, 1.22–1.37; P < .001), all-cause readmission (OR, 1.37; 95% CI, 1.33–1.41; P < .001), related readmission (OR, 1.41; 95% CI, 1.36–1.46; P < .001), venous thromboembolism (OR, 1.49; 95% CI, 1.34–1.65), and death (OR, 1.59; 95% CI, 1.34–1.89; P < .001) after primary procedures. Black patients experienced lower odds of morbidity (OR, .94; 95% CI, .91–.98; P = .004) and surgical-site infection (OR, .72; 95% CI, .66–.78; P < .001).

      Conclusions

      Black patients experienced a higher risk for serious complications and required more readmissions, reoperations, and postoperative interventions. This study supports the creation of a site-level Disparities Metric for the MBSAQIP and provides the framework to do so.

      Keywords

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      Linked Article

      • Comment on: Black-versus-White racial disparities in 30-day outcomes at MBSAQIP-accredited centers: a needed quality indicator
        Surgery for Obesity and Related Diseases
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          Although it is well recognized that metabolic surgery is the most effective treatment for obesity and related comorbid conditions, outcomes do vary and disparities do exist. Using the data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry, Yang et al., found higher rates of morbidity, readmissions, reoperations and postoperative interventions among Black patients when compared to White patients.(1) Their findings mirror those reported at the state level, which indicates that variation in outcomes between Black and White patients is both a local and national phenomenon in the United States.
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