Black-versus-White racial disparities in 30-day outcomes at Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program–accredited centers: a needed quality indicator

Background: Creating a metric in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to assess Black-versus-White disparities is critical if we are to ensure equitable care for all. Objective: To investigate Black-versus-White disparities while replicating MBSAQIP methodology with regard to covariates and modeling so that the results can serve as the foundation to create a benchmarked site-level Disparities Metric for MBSAQIP. Setting: United States and Canada. Methods: Across the 2015–2019 MBSAQIP cohorts, 543,976 adults underwent primary or revision sleeve gastrectomy or Roux-en-Y gastric bypass and were reported as either White or Black. Using a set of covariates derived from published MBSAQIP performance models, we performed multivariable logistic modeling with 10-fold cross-validation for the 11 outcomes evaluated in MBSAQIP Semiannual Reports, plus venous thromboembolism (VTE) and death. We analyzed primary and revision cases separately. Results: After risk adjustment, Black patients experienced higher odds of all-occurrence morbidity (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.19–1.25; P <.001), serious events (OR, 1.08; 95% CI, 1.04–1.13; P <.001), all-cause intervention (OR, 1.31; 95% CI, 1.24–1.37; P <.001), related intervention (OR, 1.29; 95% CI, 1.22–1.37; P <.001), all-cause readmission (OR, 1.37; 95% CI, 1.33–1.41; P <.001), related readmission (OR, 1.41; 95% CI, 1.36–1.46; P <.001), venous thromboembolism (OR, 1.49; 95% CI, 1.34–1.65; P <.001), and death (OR, 1.59; 95% CI, 1.34–1.89; P <.001) after primary procedures. Black patients experienced lower odds of morbidity (OR,.94; 95% CI,.91–.98; P =.004) and surgical-site infection (OR,.72; 95% CI,.66–.78; P <.001). Conclusions: Black patients experienced a higher risk for serious complications and required more readmissions, reoperations, and postoperative interventions. This study supports the creation of a site-level Disparities Metric for the MBSAQIP and provides the framework to do so.