Examining the Hispanic Paradox in Bariatric Surgery

Abstract Background The obesity rate for Hispanics is significantly higher than that of white, non-Hispanics in the United States, yet Hispanics undergo disproportionately fewer metabolic and bariatric surgery (MBS) procedures. This study utilized the MBSAQIP data registry to examine potential differences in pre-operative comorbidities and post-operative outcomes in Hispanic adults undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) procedures in the United States. Methods Participant User Files from the MBSAQIP were reviewed for patients undergoing SG or RYGB (2015-2017). Patients were grouped by race (Hispanic versus all other races) and primary procedure performed. Variables for major and minor post-operative complications were combined. A univariate analysis was performed on unmatched and propensity matched cohorts. Results After applying exclusions, 53,353 (13.7%) Hispanic patients and 335,299 non-Hispanic patients remained. A univariate analysis demonstrated Hispanics had the lowest pre-operative comorbidity profile compared to all other races and decreased rates of major and minor post-operative complications. Using matched cohort data, when complications were assessed and grouped as major/minor complications, rates of major and minor complications in Hispanics were lower in the RYGB group, despite Hispanic patients having higher leak rates. Similarly, there were no differences between Hispanic/non-Hispanic SG-patients in overall major/minor complication rates despite Hispanic patients exhibiting higher VTE and lower bleeding compared to non-Hispanic patients. Conclusion Hispanic patients undergo disproportionately low rates of MBS procedures and present with lower incidence of pre-operative comorbidities. Additionally, Hispanic patients have the same or decreased incidence of post-operative complications compared to non-Hispanic patients, thereby corroborating the Hispanic paradox.