Male gender is an independent risk factor for patients undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass: an MBSAQIP® database analysis

Dugan, Nicholas; Thompson, Kyle J.; Barbat, Selwan; Prasad, Tanushree; McKillop, Iain H.; Maloney, Sean R.; Roberts, Alexandra J.; Gersin, Keith S.; Kuwada, Timothy S.; Nimeri, Abdelrahman

doi:10.1007/s00464-019-07106-0

Cited by 25 publications

(17 citation statements)

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“…For decades, clinical studies have consistently found that women are more likely to pursue bariatric surgery than men. 47 , 48 , 49 , 50 Moreover, although men may have greater positive postoperative psychological outcomes, 47 male sex is independently associated with major postoperative complications, mortality, and lower weight loss. 47 , 50 , 51 , 52 Very limited data exist surrounding the association of bariatric surgery with vascular function with respect to sex, with small studies showing changes in CIMT after surgery.…”

Section: Discussionmentioning

confidence: 99%

“… 47 , 48 , 49 , 50 Moreover, although men may have greater positive postoperative psychological outcomes, 47 male sex is independently associated with major postoperative complications, mortality, and lower weight loss. 47 , 50 , 51 , 52 Very limited data exist surrounding the association of bariatric surgery with vascular function with respect to sex, with small studies showing changes in CIMT after surgery. 53 , 54 Our finding that both sexes had comparable percentage of weight loss and derived similar improvement in both macrovascular and microvascular function following weight loss surgery is of public health importance.…”

Section: Discussionmentioning

confidence: 99%

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Association of Bariatric Surgery With Vascular Outcomes

et al. 2021

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IMPORTANCE Bariatric surgical weight loss is associated with reduced cardiovascular mortality; however, the mechanisms underlying this association are incompletely understood.OBJECTIVES To identify variables associated with vascular remodeling after bariatric surgery and to examine how sex, race, and metabolic status are associated with microvascular and macrovascular outcomes. DESIGN, SETTING, AND PARTICIPANTSThis population-based longitudinal cohort included 307 individuals who underwent bariatric surgery. Participants were enrolled in the bariatric weight loss program at Boston Medical Center, a large, multi-ethnic urban hospital, with presurgical and postsurgical assessments. Data were collected from December 11, 2001 to August 27, 2019. Data were analyzed in September 2019. EXPOSURE Bariatric surgery. MAIN OUTCOMES AND MEASURES Flow-mediated dilation (FMD) and reactive hyperemia (RH) (as measures of macrovascular and microvascular function, respectively) and clinical variables were measured preoperatively at baseline and at least once postoperatively within 12 months of the bariatric intervention. RESULTS A total of 307 participants with obesity (mean [SD] age, 42 [12] years; 246 [80%] women; 199 [65%] White; mean [SD] body mass index, 46 [8]) were enrolled in this study. Bariatric surgery was associated with significant weight loss and improved macrovascular and microvascular function across subgroups of sex, race, and traditional metabolic syndrome (mean [SD] pre-vs postsurgery weight: 126 [25] kg vs 104 [25] kg; P < .001; mean [SD] pre-vs postsurgery FMD: 9.1% [5.3] vs 10.2% [5.1]; P < .001; mean [SD] pre-vs postsurgery RH: 764% [400] vs 923% [412]; P < .001). Factors associated with change in vascular phenotype correlated most strongly with adiposity markers and several metabolic variables depending on vascular territory (eg, association of weight change with change in RH: estimate, −3.2; 95% CI, −4.7 to −1.8; association of hemoglobin A 1c with change in FMD:estimate, −0.5; 95% CI, −0.95 to −0.05). While changes in macrovascular function among individuals with metabolically healthy obesity were not observed, the addition of biomarker assessment using high-sensitivity C-reactive protein plasma levels greater than 2 mg/dL identified participants with seemingly metabolically healthy obesity who had low-grade inflammation and achieved microvascular benefit from weight loss surgery. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that bariatric intervention is associated with weight loss and favorable remodeling of the vasculature among a wide range of individuals with cardiovascular risk. Moreover, differences in arterial responses to weight loss surgery (continued) Key Points Question Is bariatric surgical weight loss intervention for obesity associated with microvascular and macrovascular outcomes, and are they differentially associated with sex, race, and metabolic status? Findings In 307 individuals with obesity who were followed up after bariatric surgery, the procedure was associated with ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Bariatric Surgery With Vascular Outcomes

et al. 2021

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“…A Chi-square test for categorical variables was used. Covariate matching was performed by nearest neighbor matching algorithm using the MatchIt package [10] with matching being performed based on patient demographics (age, BMI, and race) and comorbid risk factors (diabetes requiring insulin, hypertension (HTN) requiring medication, gastroesophageal reflux disease [GERD], cardiac conditions, hyperlipidemia, history of deep venous thromboembolism [DVT], venous stasis, anticoagulation therapy, renal conditions, previous foregut surgery, smoking status, functional independence, mobility status, oxygen usage, obstructive sleep apnea, and chronic steroid usage). Distributions of covariates between control and treatment groups were assessed by absolute mean differences between groups ( Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Major complications were defined as acute renal failure, cardiac arrest requiring cardiopulmonary resuscitation, coma > 24 h, cerebral vascular accident (CVA), myocardial infarction (MI), ventilator use ≥ 48 h, pneumonia, progressive renal insufficiency, pulmonary embolism (PE), sepsis, septic shock, unplanned intubation, and/or unplanned admission to the intensive care unit (ICU). A classification of minor complications included wound disruption, surgical site infection (SSI), deep surgical site infection (dSSI), organ space surgical site infection (osSSI), and urinary tract infections (UTI) [10]. Following grouping by race (AA versus non-AA patients), a subgroup analysis was performed based on the type of procedure performed (RYGB or SG).…”

Section: Patient Demographicsmentioning

confidence: 99%

Outcomes of Bariatric Surgery in African Americans: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Data Registry

et al. 2020

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Background The incidence of obesity is disproportionally high in African Americans (AA) in the United States. This study compared outcomes for AA patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) with non-AA patients. Methods The MBSAQIP database was reviewed for RYGB and SG patients (2015-2017). Patients were identified as AA or non-AA and grouped to RYGB or SG. Combined and univariate analyses were performed on unmatched/propensity matched populations to assess outcomes. Results After applying exclusion criteria, 75,409 AA and 354,305 non-AA patients remained. Univariate analysis identified AA-RYGB and AA-SG patients were heavier and younger than non-AA patients. Overall, AA patients tended to have fewer preoperative comorbidities than non-AA patients with the majority of AA comorbidities related to hypertension and renal disease. Analysis of propensity matched data confirmed AA bariatric surgery patients had increased cardiovascular-related disease incidence compared with non-AA patients. Perioperatively, AA-RYGB patients had longer operative times, increased rates of major complications/ICU admission, and increased incidence of 30-day readmission, re-intervention, and reoperation, concomitant with lower rates of minor complications/superficial surgical site infection (SSI) compared with non-AA patients. For SG, AA patients had longer operative times and higher rates of major complications and 30-day readmission, re-intervention, and mortality, coupled with fewer minor complications, superficial/organ space SSI, and leak. Conclusion African American patients undergoing bariatric surgery are younger and heavier than non-AA patients and present with different comorbidity profiles. Overall, AAs exhibit worse outcomes following RYGB or SG than non-AA patients, including increased mortality rates in AA-SG patients.

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“… 10 After controlling for comorbidities, male gender is still an independent risk factor for both LSG and RYBG. 15 Thus, these worse outcomes in males cannot be attributed to age and preoperative co-morbidities. Some studies have shown that male gender is not an independent risk factor specifically for bariatric-related mortality.…”

Section: Discussionmentioning

confidence: 99%

Gender as a Deterministic Factor in Procedure Selection and Outcomes in Bariatric Surgery

Bal¹,

Ilonzo²,

Adediji³

et al. 2021

JSLS

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Background and Objectives: With obesity rates rising in the United States, bariatric surgery has become a well-established and effective treatment for morbid obesity and its comorbid conditions. Laparoscopic Roux-en-Y gastric bypass and laparoscopic Sleeve Gastrectomy are two of the more common bariatric procedures. This study analyzes whether gender differences play a role in procedure selection and outcomes following either procedure. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program database for years 2015 to 2017, we assessed demographics, postoperative complications, and readmission rates. Chi-square analysis, student t-test, and propensity analyses were performed appropriately. Results: Data review found that men presenting for bariatric surgery had a higher incidence of comorbidities and higher body mass index than women. More men than women underwent Sleeve Gastrectomy (68.5% vs 63.0%, P <0.0001), while more women than men underwent Laparoscopic Roux-en-Y gastric bypass (37.0% vs 31.5%, P < 0.0001). In the Laparoscopic Roux-en-Y group, men experienced more postoperative complications, including cardiac arrest (0.2% vs 0.1%, P = 0.02) and unplanned intubation (0.4% vs 0.2%, P = 0.02). In the Sleeve Gastrectomy group, men experienced more postoperative complications, including myocardial infarction (0.2% vs 0.1%, P = 0.006). In both groups, women experienced higher rates of unplanned readmissions (3.5% vs 2.8%, P = 0.0012). Conclusions: This study found that men are more likely to undergo Sleeve Gastrectomy than Laparoscopic Roux-en-Y gastric bypass, despite higher complication rates for both. Women have higher rates of unplanned readmission rates regardless of procedure, despite lower postoperative morbidity.

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Male gender is an independent risk factor for patients undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass: an MBSAQIP® database analysis

Cited by 25 publications

References 16 publications

Association of Bariatric Surgery With Vascular Outcomes

Association of Bariatric Surgery With Vascular Outcomes

Outcomes of Bariatric Surgery in African Americans: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Data Registry

Gender as a Deterministic Factor in Procedure Selection and Outcomes in Bariatric Surgery

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