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Surg Obes Relat Dis. 2019 Apr;15(4):575-581. doi: 10.1016/j.soard.2019.01.025. Epub 2019 Jan 31.

The impact of socioeconomic factors on the early postoperative complication rate after laparoscopic gastric bypass surgery: A register-based cohort study.

Author information

1
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. Electronic address: erik.stenberg@regionorebrolan.se.
2
Department of Community Medicine and Public Health, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department for Sustainable Development, Region Örebro County, Örebro, Sweden.
3
Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
4
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
5
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Abstract

BACKGROUND:

Socioeconomic factors may influence the outcome of certain surgical procedures, but it is not known whether such factors influence the risk for postoperative complication after bariatric surgery.

OBJECTIVES:

Determining whether different socioeconomic factors influence the risk for postoperative complication after laparoscopic gastric bypass surgery.

SETTING:

Nationwide in Sweden.

METHODS:

Retrospective register-based cohort study that includes all primary laparoscopic gastric bypass procedures in Sweden between 2010 and 2016, using data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, and the Swedish Population Register. Main outcome measures were occurrence and severity of early postoperative complications.

RESULTS:

Included in this study were 41,537 patients with 30-day follow-up percentage of 96.7%. Study groups with increased risk for postoperative complication (age, sex, body mass index, and co-morbidity adjusted-odds ratio with 95% confidence intervals) were as follows: being divorced, a widow, or a widower (1.14 [1.03-1.23]); receiving disability pension (1.37 [1.23-1.53]) or social assistance (1.22 [1.07-1.40]); and being first- (1.22 [1.04-1.44]) or second-generation (1.20 [1.09-1.32]) immigrant. In contrast, being single (.90 [.83-.99]), having higher disposable income (50th-80th percentile: .84 [.76-.93]; >80th percentile: .84 [.72-.98]), and living in a medium (.90 [.83-.98]) or small (.84 [.76-.92]) town were associated with lower risk. Increased risk for severe postoperative complication was seen for divorced, widowm, or widower (1.30 [1.12-1.52]) and those receiving disability pension (1.37 [1.16-1.61]) or social assistance (1.32 [1.08-1.62]), while higher disposable income (50th-80th percentile: .79 [.68-.92]; >80th percentile .57 [.46-.72]) was associated with lower risk.

CONCLUSION:

Socioeconomic factors influence the risk for early postoperative complication after laparoscopic gastric bypass surgery. The impact is not enough to exclude patients from surgery, but they must be taken into account in preoperative risk assessment.

KEYWORDS:

Gastric bypass; Laparoscopy; Postoperative complication; Risk factor; Socioeconomic

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