{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:36:03Z","timestamp":1790962563109,"version":"4.1.0"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2022,10,1]]},"abstract":"<jats:sec id=\"ab-soi220058-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Bariatric surgery is the most effective treatment for severe obesity; yet it is unclear whether the long-term safety and comparative effectiveness of these operations differ across racial and ethnic groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220058-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) across racial and ethnic groups in the National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220058-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This was a retrospective, observational, comparative effectiveness cohort study that comprised 25 health care systems in the PCORnet Bariatric Study. Patients were adults and adolescents aged 12 to 79 years who underwent a primary (first nonrevisional) RYGB or SG operation between January 1, 2005, and September 30, 2015, at participating health systems. Patient race and ethnicity included Black, Hispanic, White, other, and unrecorded. Data were analyzed from July 1, 2021, to January 17, 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220058-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>RYGB or SG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220058-8\">\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>\n                      Percentage total weight loss (%TWL); type 2 diabetes remission, relapse, and change in hemoglobin A\n                      <jats:sub>1c<\/jats:sub>\n                      (HbA\n                      <jats:sub>1c<\/jats:sub>\n                      ) level; and postsurgical safety and utilization outcomes (operations, interventions, revisions\/conversions, endoscopy, hospitalizations, mortality, 30-day major adverse events) at 1, 3, and 5 years after surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220058-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 36\u202f871 patients (mean [SE] age, 45.0 [11.7] years; 29\u202f746 female patients [81%]) were included in the weight analysis. Patients identified with the following race and ethnic categories: 6891 Black (19%), 8756 Hispanic (24%), 19\u202f645 White (53%), 826 other (2%), and 783 unrecorded (2%). Weight loss and mean reductions in HbA\n                      <jats:sub>1c<\/jats:sub>\n                      level were larger for RYGB than SG in all years for Black, Hispanic, and White patients (difference in 5-year weight loss: Black, \u22127.6%; 95% CI, \u22128.0 to \u22127.1;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;amp;lt; .001; Hispanic, \u22126.2%; 95% CI, \u22126.6 to \u22125.9;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;amp;lt; .001; White, \u22125.9%; 95% CI, \u22126.3 to \u22125.7;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;amp;lt; .001; difference in change in year 5 HbA\n                      <jats:sub>1c<\/jats:sub>\n                      level: Black, \u22120.29; 95% CI, \u22120.51 to \u22120.08;\n                      <jats:italic>P<\/jats:italic>\n                      = .009; Hispanic, \u22120.45; 95% CI, \u22120.61 to \u22120.29;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;amp;lt; .001; and White, \u22120.25; 95% CI, \u22120.40 to \u22120.11;\n                      <jats:italic>P<\/jats:italic>\n                      = .001.) The magnitude of these differences was small among racial and ethnic groups (1%-3% of %TWL). Black and Hispanic patients had higher risk of hospitalization when they had RYGB compared with SG (hazard ratio [HR], 1.45; 95% CI, 1.17-1.79;\n                      <jats:italic>P<\/jats:italic>\n                      = .001 and 1.48; 95% CI, 1.22-1.79;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;amp;lt; .001, respectively). Hispanic patients had greater risk of all-cause mortality (HR, 2.41; 95% CI, 1.24-4.70;\n                      <jats:italic>P<\/jats:italic>\n                      = .01) and higher odds of a 30-day major adverse event (odds ratio, 1.92; 95% CI, 1.38-2.68;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;amp;lt; .001) for RYGB compared with SG. There was no interaction between race and ethnicity and operation type for diabetes remission and relapse.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220058-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>\n                      Variability of the comparative effectiveness of operations for %TWL and HbA\n                      <jats:sub>1c<\/jats:sub>\n                      level across race and ethnicity was clinically small; however, differences in safety and utilization outcomes were clinically and statistically significant for Black and Hispanic patients who had RYGB compared with SG. These findings can inform shared decision-making regarding bariatric operation choice for different racial and ethnic groups of patients.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamasurg.2022.3714","type":"journal-article","created":{"date-parts":[[2022,8,31]],"date-time":"2022-08-31T11:33:35Z","timestamp":1661945615000},"page":"897","source":"Crossref","is-referenced-by-count":42,"title":["Comparative Safety and Effectiveness of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy for Weight Loss and Type 2 Diabetes Across Race and Ethnicity in the PCORnet Bariatric Study Cohort"],"prefix":"10.1001","volume":"157","author":[{"given":"Karen J.","family":"Coleman","sequence":"first","affiliation":[{"name":"Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Wellman","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie L.","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Center for Health Research, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly B.","family":"Conroy","sequence":"additional","affiliation":[{"name":"University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Callie","family":"Hlavin","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina H.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology & Prevention, and Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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