The impact of gender, race, and ethnicity on bariatric surgery outcomes

BACKGROUND

The rates of postoperative complications can vary among specific patient populations.

OBJECTIVES

The aim of this study is to examine how gender, race, and ethnicity can affect short-term postoperative complications in bariatric surgery patients.

SETTING

United States.

METHODS

Patients who underwent bariatric surgery between the years 2016 and 2021 were included and stratified based on gender, race/ethnicity, and procedure type. The 30-day outcomes were assessed using Clavien-Dindo (CD) classification of III-V. Wilcoxon rank-sum test was performed to compare continuous variables among groups and Chi-squared test for categorical variables. Logistic regression was performed to examine the effects of gender, race/ethnicity on CD classification ≥ III complications by the procedure type.

RESULTS

A total of 975,642 bariatric surgery patients were included. Descriptive univariate analysis showed that CD ≥ III complications were higher among non-Hispanic blacks (NHB) and lowest in Hispanic patients, regardless of their gender, except in the duodenal switch DS group, where non-Hispanic whites (NHW) had the lowest complication rate. There was no difference between male and female patients with regards to postoperative complications, except in the sleeve gastrectomy (SG) group, where NHW males had more complications than NHW females. Sleeve gastrectomy showed the lowest complication rates followed by gastric bypass and DS in all groups. In multivariate logistic regression model, for both females and males NHBs had higher odds of postoperative complications compared to NHWs in sleeve gastrectomy (Female aOR:1.31, 95% CI: [1.23-1.40]; Male aOR:1.24, 95% CI: [1.08-1.43], P < .001) and gastric bypass (Female aOR:1.24, 95% CI: [1.16-1.33]; Male aOR:1.25, 95% CI: [1.06-1.48], P < .01).

CONCLUSIONS

Non-Hispanic Black patients are at a higher rate of developing CD ≥ III complications compared to non-Hispanic Whites after bariatric surgery. The male gender was not a significant risk factor for serious postoperative complications. Among the different types of bariatric procedures, sleeve gastrectomy has the lowest rates of severe complications, followed by gastric bypass and duodenal switch. These results highlight the significance of considering gender, race, ethnicity, and procedure type during preoperative evaluation, surgical planning, and postoperative care.

Outcomes in robotic-assisted compared to laparoscopic-assisted colorectal surgery in a newly established colorectal tertiary center: a retrospective comparative cohort study

The robotic platform matches or surpasses laparoscopic surgery in postoperative results. However, limited date and slow adoption are noticed in the middle east. We aimed to report outcomes of robotic and laparoscopic colorectal surgery performed by fellowship-trained robotic colorectal surgeons and compare it to larger more experienced centers. Retrospective review of prospectively collected data between 2021 and 2023 of 107 patients who had robotic-assisted or laparoscopic-assisted colorectal surgery was included in the study. The outcomes were overall morbidity, serious morbidity, mortality, conversion to open, length of hospital stay, and the quality of oncological specimen. Of 107 patients, 57 were in the robotic and 50 were in the laparoscopic surgery groups. Overall, there were no significant differences in overall morbidity (46.8 vs. 53.2%, p = 0.9), serious morbidity (10.5 vs. 8%, p = 0.7), or mortality (0 vs. 4%, p = 0.2). Regarding oncological outcomes, there were no significant difference between the two groups regarding the number of lymph node harvested (17.7 ± 6.9 vs 19.0 ± 9.7, p = 0.5), R0 resections (92.7 vs. 87.1%, p = 0.5), and the rate of complete mesorectal excision (92.7 vs. 71.4%, p = 0.19). The study found that the robotic group had an 86% reduction in conversion rate to open surgery compared to the laparoscopic group, despite including more obese and physically dependent patients (OR = 0.14, 95% CI 0.03-0.7, p = 0.01). Robotic surgery appears to be a safe and effective as laparoscopic surgery in smaller colorectal surgery programs led by fellowship-trained robotic surgeons, with outcomes comparable to those of larger programs.

First Assistant In Bariatric Surgery: A Comparison Between Laparoscopic And Robotic Approaches: A 4-Year Analysis of the MBSAQIP Database (2016-2019)

PURPOSE

The first assistant (FA) plays an important role in the operating room for bariatric surgery. The aim of this study was to examine the relationship between the type of FA and operative time (OT) and postoperative outcomes comparing robotic and laparoscopic approaches in bariatric surgery.

METHODS AND MATERIALS

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data for 2016-2019 was queried. Log-normal regression was performed to evaluate the association of FAs and OT variations within and between groups. We used logistic regression to examine the relationship between the type of FA and 30-day outcomes across all procedures and approaches.

RESULTS

A total of 691,789 patients who underwent robotic (R), and laparoscopic (L) sleeve gastrectomy (SG), Roux-en-Y gastric-bypass (RYGB), and duodenal switch (DS) were included. The percentage variation of OT was higher in the laparoscopic group (L-SG: 8.18%, L-RYGB: 9.88%, and L-DS: 15.00%) compared to the robotic group (R-SG: 2.43%, R-RYGB: 5.76%, and R-DS: 0.80%). There was not a significant difference in 30-day outcomes between laparoscopic and robotic approaches for the same procedures.

CONCLUSIONS

The FA was associated with a decreased variability in OT in the robotic cohort compared to the laparoscopic group with no significant difference in complication rates. These results suggest that the robotic approach may decrease the need for skilled FAs in bariatric procedures.

Prevalence of Tobacco Smoking and Associated Risk Factors Among Public Sector Employees in Kuwait: A Cross-Sectional Study

Introduction There needs to be more evidence about the tobacco products utilized by individuals who smoke and the primary determinants contributing to the development of smoking behavior. Our study aimed to assess the prevalence and factors associated with using one or more tobacco products among employees from various ministries in Kuwait. Methods A cross-sectional study was conducted among employees in different ministries in Kuwait from December 27, 2018, to January 3, 2019. A questionnaire about smoking status and socio-demographic variables was used.  Results There was a total of 1057 participants in this study. Of the participants, 26% (n=275) reported using at least one tobacco product. The proportion of smoking of at least one tobacco product was higher among men (n=243, 46.5%) than women (n=32, 6%). Among smokers, 1.5%, 5.9%, and 18.6% reportedly use only three, two, and one tobacco products, respectively. Of the study participants, 26% were smokers, 20.3% were exclusively cigarette smokers, and 21.8% reportedly started cigarette smoking at the age of 15 years or less. Male compared to female workers had higher odds of being smokers of at least one tobacco product (adjusted OR= 15.3, 95% CI= 10.0-23.4). Participants were significantly (p= 0.009) more likely to use at least one tobacco product if their monthly income in Kuwaiti Dinars ranged from 501-1000 KD (adjusted OR= 1.9, 95% CI= 1.2-3.0) or 1501-2000 KD (adjusted OR= 2.3, 95% CI= 1.2-4.5) compared to those who had monthly income range 500 KD or less. Conclusion The male gender and high income of the participants were significant predictors of the use of at least one tobacco product. Anti-smoking campaigns, mass media interventions, and increasing tobacco product taxes may minimize this population's tobacco consumption.