Roux-en-Y Gastric Bypass May Not Be As Safe As Sleeve Gastrectomy for Black and Latino/a/x Patients

Black male patient sitting in hospital bed speaking to female doctor

Even though severe obesity is disproportionate by racial and ethnic group in the U.S., there’s limited evidence about whether metabolic and bariatric surgery outcomes differ by race/ethnicity.

In a large, multicenter comparative effectiveness study, Caroline M. Apovian, MD, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, and colleagues determined the variability of weight loss and hemoglobin A1C (HbA1C) across racial/ethnic groups was small after Roux-en-Y gastric bypass (RYGB) as compared with sleeve gastrectomy (SG). However, safety concerns were greater for Black and Latino/a/x patients after RYGB than after SG, as they report in JAMA Surgery.


In 2016, the National Patient-Centered Clinical Research Network (PCORnet) funded the PCORnet Bariatric Study (PBS), a retrospective, observational cohort study designed to compare the safety and effectiveness of RYGB and SG in 11 geographically diverse partner networks.

The PBS involved 36,871 adults and adolescents (12–79 years old; mean age, 45; 81% female) who underwent primary RYGB or SG between January 1, 2005, and September 30, 2015, at 41 healthcare systems. Patients self-identified as Black (19%), Latino/a/x (24%), white (53%), or other (2%). Race was unrecorded for 2%.

25 sites agreed to participate in the current analysis. Three cohorts were created:

  • All 36,871 patients were analyzed for weight loss at one, three, and five years after surgery
  • 8,407 were analyzed for remission of type 2 diabetes (T2D; first postsurgical occurrence of HbA1C <6.5% after at least six months without diabetes medication), T2D relapse (HbA1C level ≥6.5% and/or a prescription for diabetes medication after remission) and change in HbA1C level at one, three and five years after surgery
  • 32,853 were analyzed for safety and utilization; the primary outcome of interest was time to the first occurrence of a gastrointestinal operation or intervention across five years of follow-up

Weight Loss

Weight loss was better for RYGB than SG in all years for Black, Latino/a/x, and white patients. At year five, the difference in mean percentage total weight loss between RYGB and SG was (P<0.001 for all comparisons):

  • Black: −7.6%
  • Latino/a/x: −6.2%
  • White: −5.9%
  • Other races: −6.0%

T2D Remission, Relapse and Change in HbA1C

Rates of T2D remission were similar with RYGB and SG in all racial/ethnic groups, except that Latino/a/x patients had higher rates with RYGB (HR, 1.19; P=0.002).

All racial/ethnic groups experienced lower rates of T2D relapse with RYGB than with SG:

  • Black—HR, 0.73 (P=0.02)
  • Latino/a/x—HR, 0.75 (P=0.01)
  • White—HR, 0.76 (P=0.006)
  • Other races—HR, 0.56 (P=0.04)

For all years studied, differences in mean HbA1C level were significantly larger for RYGB than SG for Black, Latino/a/x, and white patients.

Safety and Utilization

The three largest racial and ethnic groups had a significantly higher risk of gastrointestinal intervention or operation after RYGB than SG. All three groups also had a significantly higher risk of endoscopy with RYGB than SG.

Only for Black and Latino/a/x patients was the risk of hospitalization significantly higher after RYGB than after SG:

  • Latino/a/x—HR, 1.37 (P<0.001)
  • Black—HR, 1.30 (P<0.001)
  • White—HR, 1.05 (P=0.15)

Of particular concern, Latino patients who had RYGB were at higher risk of all-cause mortality and had higher odds of a 30-day major adverse event than those who had SG:

  • Mortality—HR, 2.41 (P=0.01)
  • Major adverse event—adjusted OR, 1.92 (P<0.001)

Those two risks were not increased for any other racial group.

Takeaway Message

These results suggest that shared decision-making conversations about the choice of bariatric operation should be tailored to the race/ethnicity of the patient.

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