Date of Award

January 2021

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Melinda Irwin

Abstract

Bariatric surgery is increasingly becoming a common long-term treatment option for obesity. This study assessed racial/ethnic disparities in surgery type and short-term outcomes of Laparoscopic Sleeve Gastrectomy (LSG) and Roux-en-Y Gastric Bypass (RYGB). Specifically, it examined racial/ethnic disparities in (a) surgery type, RYGB vs. LSG (b) 30-day postoperative percent of total weight loss (%TWL), and (c) 30-day postoperative complication outcomes via Clavien-Dindo complication grades. Patients (n=143,202) who underwent RYGB or LSG surgery registered in the 2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database were included in study analysis. Multivariable logistic and linear regression analyses were conducted with adjustment of key covariates. Racial/ethnic disparities in the type of surgery persisted after multivariate adjustments. Hispanic and non-Hispanic Black (NHB) patients were at lower odds of undergoing RYGB compared to LSG (AOR = 0.90, 95% CI 0.86 – 0.93; P <0.001 and AOR = 0.62, 95% CI 0.60 - 0.64; p < 0.001 respectively) relative to non-Hispanic White (NHW) patients. Although long-term randomized controlled trials have found LSG and RYGB to be equally efficient for weight loss, there has been an emerging worldwide trend towards LSG due to its favorable early safety profile and relative technical simplicity. In terms of weight-loss, NHB and Hispanic patients had 0.04% (95% CI 0.01–0.08; P =0.02) and 0.17% (95% CI 0.13-0.22; p < 0.001) higher %TWL compared to NHWs. Yet, the clinical significance of these small differences in %TWL is uncertain for long-term outcomes. Lastly, low-grade surgery complication outcomes occurred at disproportionate rates among different racial/ethnic populations. The odds of having Grade I and Grade II complications were 40% (AOR – 1.40; 95% CI 1.32-1.48; p <0.001) and 17% (AOR – 1.17; 95% CI 1.04-1.32; p=0.007) higher for NHB patients compared to NHW patients. Further studies are needed to better optimize the strategies that enable the best outcomes in bariatric procedures and minimize racial/ethnic disparities.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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