Background

Disparities are a pressing issue for patients eligible for sleeve gastrectomy (SG). Minorities might not receive appropriate care timely or experience worse surgical outcomes. This study explores correlations between socioeconomic factors and the likelihood of undergoing SG at class II versus III obesity, as well as outcomes among SG patients nationwide.

Methods

We analyzed the National Inpatient Sample (NIS) from 2015 to 2017. We used the NIS demographics (age, race, sex, insurance, income quartile, hospital location, etc.) as independent variables. Outcomes of interest included hospital length of stay (LOS), mortality, obesity level at SG, and in-hospital complications. Univariate analysis included Chi-Square test for categorical and t-test for continuous variables. Multivariate analysis included logistic regression for categorical and generalized least squares regression for continuous variables. We controlled for comorbidities using the Elixhauser mortality and readmission indexes. An α-level of 0.05 was considered statistically significant.

Results

The sample was representative of 286,290 SG patients. Black patients had a higher rate (74.9%) of SG at class III obesity than White (66.2%) and Hispanic (68.2%) patients (p<0.001). Medicare, Medicaid, and quartile 1-income patients had longer LOS and higher mortality rates (p<0.001). They were also more likely to have SG at class III obesity. Males and Black patients were more likely to experience postoperative complications.

Conclusions

Our nationwide study revealed that socioeconomic disparities persist in SG patients. After controlling for comorbidities, sex, race, insurance type, and income quartile had a significant impact on most outcome variables.