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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Article info
Publication history
Published online: December 23, 2022
Accepted:
December 17,
2022
Received:
September 7,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.
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- Comment on: Black-versus-White racial disparities in 30-day outcomes at MBSAQIP-accredited centers: a needed quality indicatorSurgery for Obesity and Related Diseases
- PreviewAlthough 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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