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While bariatric surgery was shown to be effective across racial and ethnic groups, the type of procedure did matter in terms of safety for Black and Hispanic patients, according to a retrospective comparative effectiveness cohort study.

Five years after surgery, both weight loss and mean reductions in HbA1c values were greater with Roux-en-Y gastric bypass (RYGB) compared with sleeve gastrectomy (SG) for all groups, reported Karen J. Coleman, PhD, of Kaiser Permanente Southern California in Pasadena, and colleagues.

Black patients saw the largest average difference in weight loss with RYGB (all P<0.001), they noted in :

• Black patients: -7.6% (95% CI -8.0 to -7.1)
• Hispanic patients: -6.2% (95% CI -6.6 to -5.9)
• White patients: -5.9% (95% CI -6.3 to -5.7)

As for change in HbA1c value, Hispanic patients saw the biggest difference with RYGB:

• Black patients: -0.29 (95% CI -0.51 to -0.08)
• Hispanic patients: -0.45 (95% CI -0.61 to -0.29)
• White patients: -0.25 (95% CI -0.40 to -0.11)

However, despite RYGB being the clear winner in terms of efficacy, it wasn't necessarily the safer option, especially for minority patients.

A higher risk of hospitalization with RYGB compared with SG was seen for Black patients (HR 1.45, 95% CI 1.17-1.79, P=0.001) and Hispanic patients (HR 1.48, 95% CI 1.22-1.79, P<0.001), while white patients saw no difference between the two procedures.

In addition, Hispanic patients had a greater risk of all-cause mortality (HR 2.41, 95% CI 1.24-4.70, P=0.01) and a higher likelihood of a 30-day major adverse event (OR 1.92, 95% CI 1.38-2.68, P<0.001) with RYGB compared with SG.

Bearing in mind that RYGB in general carries more complications than SG due to its more invasive nature, Coleman's group said that the high rate of complications seen among Black and Hispanic patients stems from a slew of reasons, including, but likely not limited to, poor access or coverage to postoperative care, healthy foods, and physical activity, as well as discrimination and structural racism.

"It would be erroneous to argue in favor of SG for racial minority patients based on the less favorable safety profile of RYGB shown in this study," noted Luise I. Pernar, MD, MHPE, of Boston Medical Center, and colleagues in an

"What the surgical community should strive for instead is to identify and eliminate the barriers to safe surgery for racial minority patients so they can benefit from the RYGB's superior weight loss and improvement of obesity-associated medical conditions without the increased risk," they explained.

They added that racial minority patients in this study were more likely to opt for SG over RYGB -- a decision likely driven by surgeon preference.

"Metabolic and socioeconomic factors may impact long-term outcomes for different groups after surgery, but the differences in the safety profiles for racial majority and minority patients must be eliminated," they urged.

For this observational study, Coleman and team included 36,871 patients ages 12 to 79 who were treated from January 2005 through September 2015 at one of the 25 U.S. healthcare systems in the . Mean age was 45, and 81% were women; 19% identified as Black, 24% as Hispanic, and 53% as white.

SG patients were more likely to be younger, have a lower BMI (49 vs 49.8), and be Black (3,963 vs 2,898) or Hispanic (4,688 vs 4,068).

For the subset of patients with diabetes at baseline, there were no significant differences among the groups between the procedures in the rate of type 2 diabetes remission or relapse.

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