NATIONAL HARBOR, Md.—Black adolescents and adults undergoing bariatric surgery procedures are less likely than their white counterparts to receive prophylaxis for venous thromboembolism (VTE), according to a recent study from the Medical University of South Carolina, in Charleston.
This was one of several racial disparities observed by Allison Frederick, MD, a general surgery research resident at MUSC, and colleagues in a review of medical records from more than 430,000 patients. Black adolescents and adults also were more likely to visit the emergency department (ED) following surgery, and comorbid conditions such as hypertension and diabetes were likely to worsen in high-risk Black patients between the adolescent and adult years. These results were presented at the 2025 annual meeting of the American Society for Metabolic and Bariatric Surgery.
“Our study identified significant disparities in comorbid conditions and postoperative outcomes among Black and white adolescents, including disparities that persist and, in many cases, worsen among Black adults,” Dr. Frederick said. “By waiting to have bariatric surgery until adulthood, these patients are at higher baseline risk for complications, with more comorbid conditions, and may not reap the benefits of having bariatric surgery at a younger age.”
The study team identified three modifiable targets: early referral and improved access to bariatric surgery for high-risk adults; standardization of in-hospital VTE prophylaxis and post-discharge prophylaxis in high-risk patients to reduce risk for pulmonary embolism (PE); and improved postoperative education and follow-up to reduce ED visits and hospital readmissions.
“With these targets in mind, we can provide earlier and better longitudinal care that can slow the trajectory of metabolic disease, reduce disease disparity across the age spectrum, and significantly improve patient quality of life,” she said.
Dr. Frederick and colleagues, including Mary Kate Bryant, MD, an assistant professor of foregut and metabolic surgery at MUSC, evaluated racial disparities in comorbidity burden and 30-day perioperative outcomes between Black and white patients undergoing metabolic surgery, and to identify disparities that may evolve or persist from adolescence into adulthood. They performed a retrospective cohort study pulling records from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database of all white or Black adolescent or adult patients undergoing primary metabolic bariatric surgeries, including sleeve gastrectomies, gastric bypasses, and duodenal switches, from 2020 to 2022. They excluded records from patients of other races and patients undergoing revisions, conversions, and endoscopic procedures.
They analyzed data from 437,604 patients, of whom 2,829 were adolescents 14 to 19 years of age and 434,775 were adults older than 19. Black individuals made up 28% of the adolescent cohort and 24% of the adult cohort. Among Black patients, just 24% of adolescents and 12% of adults were males.
Comparing comorbidities by race, investigators found that Black adolescents had higher median body mass index and median hemoglobin A1c levels, while white adolescents had higher rates of gastroesophageal reflux disease. Black adults had higher median BMI and median A1c levels in addition to higher rates of type 2 diabetes, hypertension, and renal insufficiency at the time of surgery compared with white adults.
“This points to a greater metabolic disease burden among Black adolescents, which is seen and then amplified in Black adults undergoing those same procedures,” Dr. Frederick said.
Looking at perioperative outcomes, researchers found that VTE prophylaxis was used significantly less often in all Black patients. This included both mechanical and pharmacologic prophylaxis that was received either at the time of surgery or during hospitalization, Dr. Frederick said. Researchers found 7% of white adolescents received VTE prophylaxis compared with 4% of Black adolescents, and 4% of white adults versus 3% of Black adults (P<0.001).
Additionally, the incidence of PE was higher among Black than white patients, although it was rare overall: a difference of 0.3% versus 0% of adolescents and 0.2% versus 0.09% of adults (P<0.05). The majority of thromboembolic events occurring after bariatric surgery happened after hospital discharge, Dr. Frederick said. Adherence to perioperative VTE prophylaxis and continuation of prophylaxis in high-risk patients post-discharge serve as effective strategies to reduce this risk, she noted.
Surgical site infections, anastomotic leak, and other postoperative outcomes were similar.
In post-discharge outcomes, rates of 30-day readmissions and reoperations were similar among adolescents. Black adults were more frequently admitted but had fewer reoperations than white adults. Black adolescents had more postoperative ED visits with similar 30-day follow-up, while Black adults had more ED visits and worse 30-day follow-up compared with white patients.
“Collectively, this data shows that Black patients have higher postoperative utilization of resources such as hospital readmissions or ED visits for dehydration, which may represent an opportunity for additional preoperative education, early follow-up, or use of telehealth check-ins for this population,” Dr. Frederick said.
The researchers’ work highlighted disparities observed by surgeons but also was nuanced in presenting increased comorbidities from adolescents to adults, commented Karen E. Gibbs, MD, the chair of surgery at Yale New Haven Health System’s Bridgeport Hospital, in Connecticut, following the presentation. “That nuance is important for all of us to keep in mind as we see worsening comorbidities in the adult population,” she said.
“I think we can all agree that identifying disparities in the administration of perioperative VTE prophylaxis and subsequent PE is an important, clinically significant issue and something that is actionable,” Dr. Gibbs added. The difference is “concerning, and suggests not the failure of our patients but rather the need for system-level interventions.”
Drs. Frederick and Gibbs reported no relevant financial disclosures.
This article is from the November 2025 print issue.
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