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Disparities Despite Discourse: Racial Disparities in Pediatric Metabolic and Bariatric Surgery
Zachary Ballinger1, Hayley Reddington1, Muriel Cleary2, Jonathan Green2, Kaitlyn Wong2, Nicole Cherng2, Jeremy Aidlen2
1UMass Chan Medical School, Worcester, MA, 2UMass Memorial Medical Center, Worcester, MA

Background: Metabolic and Bariatric Surgery (MBS) is superior to medical treatment for weight loss and comorbidity reduction in pediatric patients. Disparities exist between children most affected by obesity and those undergoing MBS. Eligibility criteria have been updated to expand access to care to these groups. The impact of these updates is unknown. This cross-sectional study uses contemporary data to analyze ongoing disparities in MBS.
Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database identified children aged 10-17 who underwent MBS from 2017-2022.
Results: From 2017-2022, 2229 pediatric patients underwent MBS. Patients were 70% female, 59% white, and averaged 16.1 years old. 34% self-identified as Hispanic. Asian, American Indian, Pacific Islanders made up 2% of cases. The proportion of cases performed for Black patients increased annually (Figure). Black patients were younger, had higher BMI at surgery, and higher rates of diabetes and smoking than White patients. Hispanic patients had more hypertension requiring anti-hypertensive medication. Non-Hispanic patients had higher rates of GERD, prior DVT, anticoagulant use, and smoking. Black patients were more likely to undergo robotic procedures compared to others. Outcomes were equivalent among races, though black patients are more likely to present to the emergency department within 30 days of surgery.
Conclusion: MBS remains a safe and effective treatment for pediatric obesity. Significant disparities persist despite modifications to professional guidelines. The majority of MBS is still performed for white, females, though this ratio is decreasing. Black and Hispanic patients have higher burden of comorbidities, suggesting delayed or decreased access to MBS.
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