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Kang DW, Zhou S, Torres R, Chowdhury A, Niranjan S, Rogers A, Shen C. Predicting serious postoperative complications and evaluating racial fairness in machine learning algorithms for metabolic and bariatric surgery. Surg Obes Relat Dis 2024:S1550-7289(24)00726-3. [PMID: 39232870 DOI: 10.1016/j.soard.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 08/03/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Predicting the risk of complications is critical in metabolic and bariatric surgery (MBS). OBJECTIVES To develop machine learning (ML) models to predict serious postoperative complications of MBS and evaluate racial fairness of the models. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database, United States. METHODS We developed logistic regression, random forest (RF), gradient-boosted tree (GBT), and XGBoost model using the MBSAQIP Participant Use Data File from 2016 to 2020. To address the class imbalance, we randomly undersampled the complication-negative class to match the complication-positive class. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), precision, recall, and F1 score. Fairness across White and non-White patient groups was assessed using equal opportunity difference and disparate impact metrics. RESULTS A total of 40,858 patients were included after undersampling the complication-negative class. The XGBoost model was the best-performing model in terms of AUROC; however, the difference was not statistically significant. While the F1 score and precision did not vary significantly across models, the RF exhibited better recall compared to the logistic regression. Surgery type was the most important feature to predict complications, followed by operative time. The logistic regression model had the best fairness metrics for race. CONCLUSIONS The XGBoost model achieved the highest AUROC, albeit without a statistically significant difference. The RF may be useful when recall is the primary concern. Undersampling of the privileged group may improve the fairness of boosted tree models.
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Affiliation(s)
- Dong-Won Kang
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Russell Torres
- Department of Information Technology and Decision Sciences, University of North Texas, Denton, Texas
| | | | - Suman Niranjan
- Department of Logistics and Operations Management, G. Brint Ryan College of Business, University of North Texas, Denton, Texas
| | - Ann Rogers
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Chan Shen
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
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Rafaqat W, Lagazzi E, Abiad M, Argandykov D, Proaño-Zamudio JA, Van Ee EPX, Velmahos GC, Hwabejire JO, Kaafarani HMA, DeWane MP. The overlooked factor: The impact of disability on postoperative complications after emergency general surgery procedures. Surgery 2024; 176:232-238. [PMID: 38480052 DOI: 10.1016/j.surg.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Despite more than 61 million people in the United States living with a disability, studies on the impact of disability on health care disparities in surgical patients remain limited. Therefore, we aimed to understand the impact of disability on postoperative outcomes. METHODS We performed a retrospective cohort study using the Nationwide Readmission Database (2019). We compared patients ≥18 years undergoing emergency general surgery procedures with a disability condition with those without a disability. In accordance with the Centers for Disease Control and Prevention, disability was defined as severe hearing, visual, intellectual, or motor impairment/caregiver dependency. The primary outcome was 30-day readmission rates. Secondary outcomes included hospital length of stay and 30-day complications and mortality. Patients were 1:1 propensity-matched using patient, procedure, and hospital characteristics. RESULTS Among our population of 378,733 patients, 5,877 (1.6%) patients had at least 1 disability condition. A higher proportion of patients with a disability had low household income, $1 to $45,999, and an Elixhauser Comorbidity score ≥3. Among 5,768 matched pairs, patients with a disability had a significantly higher incidence of 30-day readmission (17.2% vs 12.7%; P < .001), infectious complications (29.8% vs 19.5%; P < .001), and a longer length of stay (8 vs 6 days; P < .001). Motor impairment, the most common disability, was associated with the greatest increase in patient readmission, morbidity, and length of stay. CONCLUSION Severe intellectual, hearing, visual, or motor impairments were associated with higher readmission, morbidity, and longer length of stay. Further research is needed to understand the mechanisms responsible for these disparities and to develop interventions to ameliorate them.
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Affiliation(s)
- Wardah Rafaqat
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Emanuele Lagazzi
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - May Abiad
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Dias Argandykov
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jefferson A Proaño-Zamudio
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Elaine P X Van Ee
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - George C Velmahos
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - John O Hwabejire
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael P DeWane
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Tsumura H, Pan W, Brandon D. Exploring Differences in Intraoperative Medication Use Between African American and Non-Hispanic White Patients During General Anesthesia: Retrospective Observational Cohort Study. Clin Nurs Res 2024; 33:470-480. [PMID: 38767246 DOI: 10.1177/10547738241253652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
This study aimed to explore whether differences exist in anesthesia care providers' use of intraoperative medication between African American and non-Hispanic White patients in adult surgical patients who underwent noncardiothoracic nonobstetric surgeries with general anesthesia. A retrospective observational cohort study used electronic health records between January 1, 2018 and August 31, 2019 at a large academic health system in the southeastern United States. To evaluate the isolated impact of race on intraoperative medication use, inverse probability of treatment weighting using the propensity scores was used to balance the covariates between African American and non-Hispanic White patients. Regression analyses were then performed to evaluate the impact of race on the total dose of opioid analgesia administered, and the use of midazolam, sugammadex, antihypotensive drugs, and antihypertensive drugs. Of the 31,790 patients included in the sample, 58.9% were non-Hispanic Whites and 13.6% were African American patients. After adjusting for significant covariates, African American patients were more likely to receive midazolam premedication (p < .0001; adjusted odds ratio [aOR] = 1.17, 99.9% CI [1.06, 1.30]), and antihypertensive drugs (p = .0002; aOR = 1.15, 99.9% CI [1.02, 1.30]), and less likely to receive antihypotensive drugs (p < .0001; aOR = 0.85, 99.9% CI [0.76, 0.95]) than non-Hispanic White patients. However, we did not find significant differences in the total dose of opioid analgesia administered, or sugammadex. This study identified differences in intraoperative anesthesia care delivery between African American and non-Hispanic White patients; however, future research is needed to understand mechanisms that contribute to these differences and whether these differences are associated with patient outcomes.
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Affiliation(s)
- Hideyo Tsumura
- Duke University School of Nursing, Durham, NC, USA
- Duke University Health System, Durham, NC, USA
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Debra Brandon
- Duke University School of Nursing, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
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Kahveci AC, Dooley MJ, Johnson J, Mund AR. Are There Racial Disparities in Perioperative Pain? A Retrospective Study of a Gynecological Surgery Cohort. J Perianesth Nurs 2024; 39:82-86. [PMID: 37855762 PMCID: PMC10873002 DOI: 10.1016/j.jopan.2023.06.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/14/2023] [Accepted: 06/27/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE The purpose of this study was to examine whether racial disparities exist in immediate postoperative pain scores and intraoperative analgesic regimens in a single surgical cohort. DESIGN A single-center, retrospective analysis. METHODS This retrospective study of a single surgical cohort was conducted via chart review of the existing electronic health record. A total of 203 patients who underwent minimally invasive hysterectomy were included in the analysis. Three initially reviewed patient records were excluded from the final analysis due to the small size of their racial cohorts (two Asian or Pacific Islander and one Native American). The White patients (n = 103) and Black patients (n = 100) were compared for differences in pain scores in the postanesthesia care unit (PACU). The patients' intraoperative analgesic regimens were also compared. FINDINGS There were no significant differences between races in the postoperative pain scores in the PACU or in the analgesia administered by the anesthesia provider intraoperatively. CONCLUSIONS In this specific population, there was no evidence of racial disparities in postoperative pain or intraoperative analgesia administration. Further research is needed to understand the unique factors of the perioperative period, to see if the absence of disparities in this study is repeated in other cohorts, and to mitigate any disparities that are found.
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Affiliation(s)
- Allyson C Kahveci
- Department of Anesthesiology, Virginia Commonwealth University Health, Richmond, VA.
| | - Mary J Dooley
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Jada Johnson
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Angela R Mund
- College of Health Professions, Medical University of South Carolina, Charleston, SC
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Rajeev ND, Samaan JS, Premkumar A, Yu E, Srinivasan N, Samakar K. Providers' Knowledge and Perceptions of Bariatric Surgery: a Systematic Review. Obes Surg 2023; 33:3571-3601. [PMID: 37740831 PMCID: PMC10603000 DOI: 10.1007/s11695-023-06827-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/21/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
Bariatric surgery remains underutilized despite its proven efficacy in the management of obesity. Provider perceptions of bariatric surgery are important to consider when discussing utilization rates. PubMed, SCOPUS, and OVID databases were searched in April 2023, and 40 published studies discussing providers' knowledge and perceptions of bariatric surgery were included. There were generally positive perceptions of the efficacy of bariatric surgery, although overestimations of surgical risks and postoperative complications were common. Providers' previous training was associated with knowledge and perceptions of bariatric surgery and familiarity with perioperative management across studies. These perceptions were also associated with referral rates, suggesting that inadequate provider knowledge may contribute to bariatric surgery underutilization. We advocate for increased bariatric surgery-related education throughout all stages of medical training and across specialties.
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Affiliation(s)
- Nithya D Rajeev
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Jamil S Samaan
- Department of Medicine, Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Agnes Premkumar
- Department of General Surgery, Creighton University of Phoenix, 3100 N. Central Ave, Phoenix, AZ, 85012, USA
| | - Erin Yu
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Nitin Srinivasan
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA.
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Haley EN, Loree AM, Maye M, Coleman KJ, Braciszewski JM, Snodgrass M, Harry ML, Carlin AM, Miller-Matero LR. Racial Differences in Psychiatric Symptoms, Maladaptive Eating, and Lifestyle Behaviors After Bariatric Surgery. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01835-8. [PMID: 37874488 DOI: 10.1007/s40615-023-01835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
There are several psychological and behavioral factors associated with poorer outcomes following bariatric surgery, yet it is unknown whether and how these factors may differ by race. In this cross-sectional study, individuals who underwent bariatric surgery from 2018 to 2021 and up to 4 years post-surgery were invited to complete an online survey. Psychiatric symptoms, maladaptive eating patterns, self-monitoring behaviors, and exercise frequency were examined. Participants (N = 733) were 87% women, 63% White, with a mean age of 44 years. Analyses of covariance demonstrated that White individuals endorsed greater anxiety symptoms (p =.01) and emotional eating due to depression (p = .01), whereas Black individuals endorsed greater depression severity (p = .02). Logistic regression analyses demonstrated that White individuals were more likely to experience loss of control eating (OR= 1.7, p = .002), grazing (OR= 2.53, p <.001), and regular self-weighing (OR= 1.41, p <.001) than Black individuals, and were less likely to skip meals (OR= .61, p = .04), or partake in nighttime eating (OR= .40, p <.001). There were no racial differences in binge eating, emotional eating due to anxiety or frustration, use of a food diary, or exercise. Thus, depressive symptoms, skipping meals, and nighttime eating may be important, modifiable intervention targets to optimize the benefits of bariatric surgery and promote equitable outcomes.
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Affiliation(s)
- Erin N Haley
- Behavioral Health, Henry Ford Health, Detroit, USA.
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA.
| | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | | | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health, Detroit, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | | | - Melissa L Harry
- Essentia Institute of Rural Health, Essentia Health, Duluth, USA
| | | | - Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
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7
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Ruiz Colón GD, Harris OA. Letter: A Call for Enhanced Diversity Efforts in the Physician Pipeline in the Face of Legal Threats. Neurosurgery 2023; 93:e65-e66. [PMID: 37345916 DOI: 10.1227/neu.0000000000002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Gabriela D Ruiz Colón
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
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Gulinac M, Miteva DG, Peshevska-Sekulovska M, Novakov IP, Antovic S, Peruhova M, Snegarova V, Kabakchieva P, Assyov Y, Vasilev G, Sekulovski M, Lazova S, Tomov L, Velikova T. Long-term effectiveness, outcomes and complications of bariatric surgery. World J Clin Cases 2023; 11:4504-4512. [PMID: 37469732 PMCID: PMC10353499 DOI: 10.12998/wjcc.v11.i19.4504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/17/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
Dietary imbalance and overeating can lead to an increasingly widespread disease - obesity. Aesthetic considerations aside, obesity is defined as an excess of adipose tissue that can lead to serious health problems and can predispose to a number of pathological changes and clinical diseases, including diabetes; hypertension; atherosclerosis; coronary artery disease and stroke; obstructive sleep apnea; depression; weight-related arthropathies and endometrial and breast cancer. A body weight 20% above ideal for age, gender and height is a severe health risk. Bariatric surgery is a set of surgical methods to treat morbid obesity when other treatments such as diet, increased physical activity, behavioral changes and drugs have failed. The two most common procedures currently used are sleeve gastrectomy and gastric bypass. This procedure has gained popularity recently and is generally considered safe and effective. Although current data show that perioperative mortality is low and better control of comorbidities and short-term complications is achieved, more randomized trials are needed to evaluate the long-term outcomes of bariatric procedures. This review aims to synthesize and summarize the growing evidence on the long-term effectiveness, outcomes and complications of bariatric surgery.
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Affiliation(s)
- Milena Gulinac
- Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
| | - Dimitrina Georgieva Miteva
- Department of Genetics, Sofia University "St. Kliment Ohridski", Faculty of Biology, Sofia 1164, Bulgaria
| | | | - Ivan P Novakov
- Department of Thoraco-abdominal Surgery, Medical University Plovdiv, Plovdiv 6000, Bulgaria
| | - Svetozar Antovic
- University Clinic for Digestive Surgery, Medical Faculty, Skopje, Skopje 1000, North Macedonia
| | - Milena Peruhova
- Department of Gastroenterology, Heart and Brain Hospital, Burgas, Burgas 1000, Bulgaria
| | - Violeta Snegarova
- Clinic of Internal Diseases, Naval Hospital - Varna, Military Medical Academy, Medical Faculty, Medical University, Varna 9000, Bulgaria
| | - Plamena Kabakchieva
- Clinic of Internal Diseases, Naval Hospital - Varna, Military Medical Academy, Varna 9010, Bulgaria
| | - Yavor Assyov
- Clinic of Endocrinology, University Hospital "Alexandrovska, Sofia 1431, Bulgaria
- Department of Internal Diseases, Medical University – Sofia, Sofia 1431, Bulgaria
| | - Georgi Vasilev
- Clinic of Endocrinology and Metabolic Disorders, UMHAT "Sv. Georgi", Plovdiv 4000, Bulgaria
| | - Metodija Sekulovski
- Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, Sofia 1407, Bulgaria
- Medical Faculty, Sofia University, St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Snezhina Lazova
- Department of Pediatric, University Hospital "N. I. Pirogov", Sofia 1606, Bulgaria
- Department of Healthcare, Faculty of Public Health "Prof. Tsekomir Vodenicharov, MD, DSc", Sofia 1527, Bulgaria
| | - Latchezar Tomov
- Department of Informatics, New Bulgarian University, Sofia 1618, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
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Matabele MM, Haider SF, Wood Matabele KL, Merchant AM, Chokshi RJ. The Mediating Effect of Operative Approach on Racial Disparities in Bariatric Surgery Complications. J Surg Res 2023; 289:42-51. [PMID: 37084675 DOI: 10.1016/j.jss.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION A laparoscopic approach to bariatric surgeries confers a favorable side-effect profile as compared to an open approach. However, literature regarding the independent association of race with access to and postoperative outcomes in laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (GS) is scarce. MATERIALS AND METHODS All RYGB and GS cases recorded in American College of Surgeons National Quality Improvement Program data from 2012 to 2020 were subjected to propensity score matching to assess the independent association between Black self-identified race on access to a laparoscopic approach and postoperative complications. Finally, a series of logistic regressions enabled evaluation of the mediating effect of operative approach on racial disparities in postoperative complications. RESULTS 55,846 cases of RYGB and 94,209 cases of GS were identified. Following propensity score matching, logistic regression identified Black race as an independent predictor of open approach to RYGB (P < 0.001) and GS (P = 0.019). Black patients had increased incidence of any, minor and severe postoperative complications and unplanned readmissions in both RYGB (P < 0.001, P < 0.001, P = 0.0412, and P < 0.001, respectively) and GS (P < 0.001, P < 0.001, P = 0.0037, and P < 0.001, respectively). Open approach to RYGB was identified as a partial mediator of the independent association between Black race and any complication, minor complications, and unplanned readmission. CONCLUSIONS This methodology identified racial disparities in complications following RYGB and GS. Interestingly, reduced access to a laparoscopic approach mediated racial disparities in complications following RYGB but not GS. Further research might elucidate upstream determinants of health that catalyze these disparities.
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Affiliation(s)
- Mario M Matabele
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Syed F Haider
- General Surgery Minimally Invasive and Robotic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Aziz M Merchant
- General Surgery Minimally Invasive and Robotic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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10
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Rajeev ND, Samaan JS, Premkumar A, Srinivasan N, Yu E, Samakar K. Patient and the Public's Perceptions of Bariatric Surgery: A Systematic Review. J Surg Res 2023; 283:385-406. [PMID: 36434835 DOI: 10.1016/j.jss.2022.10.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Bariatric surgery is an effective therapeutic modality for obesity and related comorbidities, yet it remains significantly underutilized. Patient perceptions and expectations may influence the decisions of eligible patients in pursuing surgery. METHODS PubMed, SCOPUS, and OVID databases were searched in July 2022 to identify published studies discussing patient and the public's perceptions of bariatric surgery. RESULTS The literature shows participants often reported bariatric surgery to be a life-changing intervention known to induce weight loss, improve obesity-related comorbidities, and improve quality of life. However, a significant proportion of survey respondents perceived bariatric surgery as unsafe or risky. Patients belonging to racial minority groups cited higher concern with mortality risk, lower weight loss expectations, and different motivations to pursue bariatric surgery. Female patients were significantly more likely to have more positive perceptions of, and higher expectations of weight loss from, bariatric surgery. CONCLUSIONS The literature highlighted discordance between patient perceptions and the demonstrated clinical safety and efficacy profile of bariatric surgery. Overestimations of the risks, unrealistic expectations, and unfamiliarity with bariatric surgery outcomes were common findings. These perceptions of bariatric surgery may contribute to its underutilization among eligible patients. Perceptions and motivations often varied by race, region, sex, and age, which demonstrates the necessity of patient-centered education in the prereferral stage. The literature also demonstrated misconceptions of bariatric surgery among the public. Further research should explore the impact of education on the perceptions of patients and the public.
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Affiliation(s)
- Nithya D Rajeev
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Jamil S Samaan
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Agnes Premkumar
- Department of General Surgery, Creighton University of Phoenix, Phoenix, Arizona
| | - Nitin Srinivasan
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Erin Yu
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California.
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Lofton H, Ard JD, Hunt RR, Knight MG. Obesity among African American people in the United States: A review. Obesity (Silver Spring) 2023; 31:306-315. [PMID: 36695059 PMCID: PMC10107750 DOI: 10.1002/oby.23640] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023]
Abstract
Obesity is a growing public health crisis in the United States and is associated with a substantial disease burden due to an increased risk for multiple complications, including cardiovascular and metabolic diseases. As highlighted in this review, obesity disproportionately affects the African American population, women in particular, regardless of socioeconomic status. Structural racism remains a major contributor to health disparities between African American people and the general population, and it limits access to healthy foods, safe spaces to exercise, adequate health insurance, and medication, all of which impact obesity prevalence and outcomes. Conscious and unconscious interpersonal racism also impacts obesity care and outcomes in African American people and may adversely affect interactions between health care practitioners and patients. To reduce health disparities, structural racism and racial bias must be addressed. Culturally relevant interventions for obesity management have been successfully implemented that have shown benefits in weight management and risk-factor reduction. Strategies to improve health care practitioner-patient engagement should also be implemented to improve health outcomes in African American people with obesity. When managing obesity in African American people, it is critical to take a holistic approach and to consider an individual's social and cultural context in order to implement a successful treatment strategy.
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Affiliation(s)
- Holly Lofton
- NYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Jamy D. Ard
- Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Rameck R. Hunt
- Penn Medicine Princeton HealthPlainsboro TownshipNew JerseyUSA
- Rutgers RWJ Medical SchoolNew BrunswickNew JerseyUSA
| | - Michael G. Knight
- The George Washington University School of Medicine and Health SciencesWashingtonDCUSA
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Hampton L, Mocanu V, Verhoeff K, Birch DW, Karmali S, Switzer NJ. Asian race is not associated with increased 30-day serious complications or mortality: a MBSAQIP analysis of 594 837 patients. Surg Endosc 2023; 37:3893-3900. [PMID: 36720752 DOI: 10.1007/s00464-023-09898-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/16/2023] [Indexed: 02/02/2023]
Abstract
INTRODUCTION With expansion of bariatric surgery indications to include Asian patients with diabetes and body mass index (BMI) ≥ 27.5, or BMI ≥ 32.5, it is important to characterize Asian patient population undergoing bariatric surgery and assess their postoperative outcomes. METHODS This retrospective study analyzed the 2015-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. All patients undergoing Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) who self-reported as Asian or White race were included. The primary outcomes were to characterize the Asian race population in North American and to identify if Asian race was associated with serious complications or mortality at 30 days. RESULTS Overall, 594,837 patients met inclusion, with 4229 self-reporting Asian racial status. Patients of Asian race were younger (41.8 vs 45.5 years, p < 0.001) and had a lower BMI (42.8 vs 44.7 kg/m2 p < 0.001) than White patients. They were also more likely to have insulin dependent diabetes (10.9% vs 8.2%, p < 0.001), have received prior cardiac surgery (10.0% vs 1.2% p < 0.001), and suffer from renal insufficiency (1.0% vs 0.5%, p < 0.001). There were no significant differences between rates of RYGB (28.3% vs 28.9%, p = 0.4) and mean operative duration (87.7 vs 87.5 min, p = 0.7). Additionally, there were no differences in 30 day outcomes including leak (0.5% vs 0.5%, p = 0.625), bleeding (1.2% vs 1.0%, p = 0.1), serious complications (3.4% vs 3.5%, p = 0.6), or mortality (0.1% vs 0.1%, p = 0.7) and after confounder control, Asian race was not independently associated with serious complications (OR 1.0, CI 0.9-1.2, p = 0.7), or mortality (OR 1.1, CI 0.3-3.3, p = 0.1). CONCLUSIONS Despite the increased metabolic burden of Asian patients, no differences in 30-day outcomes compared to White patients occurs. This data supports evidence suggesting these patients may safely undergo bariatric surgery independent of their increased metabolic burden.
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Affiliation(s)
- Lauren Hampton
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Daniel W Birch
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Noah J Switzer
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
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Felix AS, Nafiu T, Cosgrove CM, Ewing AP, Mpody C. Racial Disparities in Surgical Outcomes Among Women with Endometrial Cancer. Ann Surg Oncol 2022; 29:8338-8344. [PMID: 36138286 PMCID: PMC10316673 DOI: 10.1245/s10434-022-12527-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Endometrial cancer (EC) is the most common gynecological cancer among women in the United States. Despite well-documented racial/ethnic disparities in EC incidence and mortality rates, limited data exist regarding disparities in hysterectomy surgical outcomes. We evaluated associations of race/ethnicity with postoperative complications, serious adverse events (SAEs), and length of hospital stay among women undergoing EC-related hysterectomy. METHODS Using National Surgical Quality Improvement Program (NSQIP) data, we identified women (≥18 years) undergoing hysterectomy to treat EC between 2014 and 2020. We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of race/ethnicity (white, black, and Latina) with postoperative complications and SAEs. We used Poisson regression with robust standard errors to calculate incidence rate ratios (IRRs) and 95% CIs for the association of race/ethnicity with length of hospital stay. RESULTS Of 22,778 women undergoing EC-related hysterectomy, 3.1% developed postoperative complications. Black (adjusted OR: 1.62; 95% CI 1.05-2.48) and Latina women (adjusted OR: 1.79; 95% CI 1.04-3.09) had higher postoperative complication risks than white women. The overall SAE incidence was 5.0%. Black women (adjusted OR: 1.55, 95% CI 1.13-2.15) had higher SAE risks than white women. Length of hospital stay was significantly longer for black women than white women (IRR: 1.18; 95% CI 1.07-1.30). CONCLUSIONS We observed racial/ethnic disparities in EC-related hysterectomy surgical outcomes in a large, diverse sample of U.S. women between 2014 and 2020. Studies to elucidate the underlying mechanisms of these racial disparities, with a focus on social context remain necessary.
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Affiliation(s)
- Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
| | - Toluwaniose Nafiu
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Aldenise P Ewing
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Christian Mpody
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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New Insights on the Association Between Socioeconomic Status and Weight Loss After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:3752-3770. [DOI: 10.1007/s11695-022-06269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
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Factors Associated With Bariatric Surgery Referral Patterns: A Systematic Review. J Surg Res 2022; 276:54-75. [PMID: 35334384 DOI: 10.1016/j.jss.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/18/2021] [Accepted: 01/26/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Bariatric surgery (BS) has been shown to effectively treat morbid obesity and improve obesity-related comorbidities. Nonetheless, BS remains underutilized among qualified patients. MATERIALS AND METHODS PubMed, SCOPUS, and OVID databases were searched to identify published comparative studies examining BS referral patterns. Data on barriers to BS referrals were examined and summarized. RESULTS Barriers to referrals stemmed largely from a lack of familiarity with safety, efficacy, and postoperative care amongst providers. Providers with previous referrals were more likely to report higher knowledge, comfort in referring patients, and ability to provide postoperative care. Provider initiated discussion of BS was positively associated with referrals. Female and younger patients were more likely to receive referrals. Furthermore, access to appropriate peri-operative resources, local bariatric programs, and insurance eligibility were associated with referral rates. Encouragingly, providers across specialties report eagerness to gain exposure and training in BS. CONCLUSIONS Lack of provider familiarity with BS efficacy, safety and postoperative care likely contributes to low utilization rates of BS. Further potential barriers in access to BS are logistic factors such as insurance coverage, limited local perioperative resources, and clinic time constraints for patient counseling. Promotion of BS amongst providers and both surgical and non-surgical trainees will likely have a significant impact on referral rates and access to this life-saving procedure. Future studies should further investigate the barriers to BS and delineate the effect size of each barrier on referral rates to efficiently increase access.
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Mohan S, Samaan JS, Premkumar A, Samakar K. History of abuse and bariatric surgery outcomes: a systematic review. Surg Endosc 2022; 36:4650-4673. [PMID: 35277764 DOI: 10.1007/s00464-022-09147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although there is evidence to support the relationship between abuse history and obesity, the association between abuse history and outcomes after bariatric surgery is not well-established. We aimed to summarize the current literature examining this relationship, as well as provide clinical recommendations to optimize postoperative outcomes. METHODS PubMed and SCOPUS databases were queried to identify relevant published studies. RESULTS Overall, 20 studies were included. Rates of the various types of abuse reported in the bariatric surgery population varied widely across studies, as did the methodology used to assess it. The majority of studies found no significant associations between abuse history and postoperative weight loss outcomes. The literature examining the relationship between abuse history and postoperative psychiatric outcomes was less conclusive. CONCLUSIONS Most current evidence demonstrates that abuse history is not associated with weight loss outcomes after bariatric surgery. Literature on postoperative psychiatric outcomes is mixed, and more robust studies are needed to further investigate the relationship between abuse history and postoperative psychiatric outcomes. Importantly, abuse history should not preclude patients from undergoing bariatric surgery. Of note, patients may benefit from careful monitoring for emotional distress and worsening of psychiatric comorbidities after surgery and psychiatric counseling and treatment when indicated.
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Affiliation(s)
- Sukriti Mohan
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Jamil S Samaan
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Agnes Premkumar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA.
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