Women Face Fewer Complications After Gastric Bypass Surgery

A study of nearly 38,000 patients found white, Hispanic, and female patients have the fewest complications and the shortest hospital stays after laparoscopic gastric bypass surgery, according to University of Nebraska Medical Center researchers who presented their findings at the annual meeting of the American Society for Metabolic & Bariatric Surgery.

According to the study, which reviewed complications, hospitalizations, readmissions and hospital costs in the first month after gastric bypass surgery, females do better than males, whites and Hispanics do better than African Americans and younger patients do better than older ones. Across all demographics, the groups with the fewest obesity-related diseases did the best. The study is one of the largest to identify differences in surgical outcomes based on demographic factors.

Researchers analyzed the University HealthSystem Consortium database of adult patients who had laparoscopic gastric bypass between 2006 and 2009 for differences in clinical outcomes based on gender, race, age, and health status before surgery. The majority of patients in the study were female (80.2%), whites (73.1%), and within the ages of 31 to 50 (56.3%).

According to the study, females have an easier time after bariatric surgery than men with 25% fewer complications (7.05% vs. 8.81%), one third fewer ICU admissions (6.73% vs. 9.87%), and a mortality rate almost five times lower (0.19% vs. 0.04%). Thirty-day hospital readmission rates were about the same (2.41% vs. 2.10%), but hospital costs for women were about $1,000 less ($14,383 vs. $15,397). Men were almost twice as likely to have more obesity-related conditions (6.4% vs. 3.3%).

The 30-day mortality rate for all racial groups was low and comparable (0.08% white vs. 0.08% African American vs. 0% Hispanic). African Americans have slightly higher rates of postsurgical complications than whites (7.99% vs. 7.31%), while Hispanics experienced fewer complications than whites (6.63% vs. 7.31%), though the differences were not statistically significant.

Compared with whites, African American patients were more likely to be readmitted within 30 days (2.32% vs. 3%), remained longer in the hospital (2.6 vs. 2.79 days) and incurred about $700 more in costs ($14,722 vs. $15,406). Hispanic patients, when compared with whites, showed lower ICU admission rates (5.2% vs. 7.46%), similar length of hospital stay (2.61 vs. 2.6 days) and about $1,000 less in overall costs ($13,688 vs. $14,722).

The study also revealed a trend towards higher risk in older patients, especially those over the age of 50. The oldest group (aged 65 and older) had a mortality rate of about 0.22% compared with no deaths in youngest group (aged 18 to 30). Older patients had a significantly higher complication rate (12.82% vs. 4.89%), more than twice the ICU admissions (11.07% vs. 4.93%), a hospitalization period that was longer by a full day (3.47 vs. 2.37 days), and costs that were higher by almost $4,000 ($17,260 vs. $13,637).

Across all demographics, disease severity was found to have a significant impact on gastric bypass outcomes. For those with the highest severity, compared with those with the lowest, the complication rate was 15 times higher (51.33% vs. 3.23), the mortality rate was 1.57% vs. 0.01%, and costs were $20,000 higher ($13,630 vs. $33,286). Researchers suggest that different levels of disease severity within the demographic groups may help account for differences in outcomes. For example, higher illness severity in males may be a reason for gender differences in postsurgery outcomes and higher illness severity among African American patients may help explain poor outcomes in this group. They noted more research into the causes of these disparities is needed.

Source: American Society for Metabolic & Bariatric Surgery