What is the clinical evidence from this study?

Study design: Cohort. Population: Severe adolescent obesity (n=5432). Intervention: COVID-19 pandemic vs. Pre-COVID period (2015-2019). Primary outcome: 30-day postoperative complications among Black patients (-3.1%, 95% CI -5.7%, -2.1%, p=0.004).

What question did this study set out to answer?

The aim is to evaluate how the COVID-19 pandemic has affected racial disparities in adolescent access to bariatric surgery.

June 17, 2026Open Access

Impact of the COVID-19 pandemic on racial disparities in adolescent bariatric surgery: an MBSAQIP analysis

NTNikita S. TharejaUniversity of California, San Diego ACAna Garcia CabreraUniversity of California, San Diego JRJ. Jeffery ReevesUC San Diego Health System

Key Result

The COVID-19 pandemic was associated with increased bariatric surgery representation for Hispanic and Black adolescents, alongside a decline in 30-day complication rates among Black patients from 3.9% to 0.8%.

Key Points

The aim is to evaluate how the COVID-19 pandemic has affected racial disparities in adolescent access to bariatric surgery.
Analysis of adolescents aged 19 or younger who underwent metabolic and bariatric surgery from 2015 to 2023.
Comparison of race/ethnicity, comorbidities, and 30-day outcomes across three phases: pre-COVID, acute COVID, and recovery.
Statistical methods included Fisher’s exact test, Kruskal–Wallis tests, and Firth penalized logistic regression.
White representation in bariatric surgery dropped from 49% pre-COVID to 32% during recovery (−17%; 95% CI −19%, −14.7%).
Hispanic representation increased from 25% to 36% (+11%; 95% CI +9.1%, +13.2%), and Black from 17% to 21% (+4%; 95% CI +2.6%, +6.2%).
Complication rates among Black adolescents decreased from 3.9% pre-COVID to 0.8% during recovery (−3.1%; 95% CI −5.7%, −2.1%; p = 0.004).

Study Design

Type

Cohort (n=5,432)

Multicenter

Yes

Structured PICO

Did the COVID-19 pandemic alter racial and ethnic composition and 30-day outcomes in adolescents undergoing metabolic and bariatric surgery?

Population

5,432 adolescents aged 19 years or younger with severe obesity who underwent metabolic and bariatric surgery, evaluated for 30-day postoperative outcomes across COVID-19 pandemic phases.

Exposure

Metabolic and bariatric surgery during acute COVID (2020–2021) and recovery (2022–2023) phases

Comparator

Metabolic and bariatric surgery during pre-COVID phase (2015–2019)

Outcome

Racial and ethnic composition, comorbidity burden, and 30-day outcomes (complications, readmission, reoperation)safety

The COVID-19 pandemic was associated with a substantial shift in the racial and ethnic composition of adolescents undergoing bariatric surgery, with increased representation of historically underserved groups.

Main Result

Effect estimate: -3.1% (95% CI -5.7%, -2.1%)

Absolute Event Rate: 0.8% vs 3.9%

Absolute Risk Reduction: 3.1%

p-value: p=0.004

Limitations

Observational design precludes causal inference.
MBSAQIP captures only patients who underwent surgery, missing disparities at the referral and evaluation stages.
Lack of socioeconomic variables such as insurance status, income, and geographic access to care.
De-identified data prevents tracking whether the same institutions contributed data across all pandemic phases.
Variable coding methodology changed across MBSAQIP data collection years, precluding reliable cross-phase comparison of several variables.
Sparse complication events across race/ethnicity and phase strata precluded adjusted regression analysis.

Abstract

Abstract Background Metabolic and bariatric surgery (MBS) is the most effective intervention for severe adolescent obesity, yet persistent disparities exist in surgical access. The COVID-19 pandemic disrupted elective surgery and may have altered access for historically underserved populations. Methods Using MBSAQIP, we identified adolescents aged 19 years or younger who underwent MBS from 2015 to 2023, stratified into three phases: pre-COVID (2015–2019), acute COVID (2020–2021), and recovery (2022–2023). Race/ethnicity was classified using Hispanic-priority methodology. Racial and ethnic composition, comorbidity burden, and 30-day outcomes were compared using Fisher’s exact and Kruskal–Wallis tests. Firth penalized logistic regression was used for sensitivity analysis of rare outcomes. Results Overall, 5432 adolescents underwent MBS from 2015 to 2023. White representation declined from 49% pre-COVID to 32% during recovery (− 17%; 95% CI − 19%, − 14.7%), while Hispanic representation increased from 25 to 36% (+ 11%; 95% CI + 9.1%, + 13.2%) and Black representation from 17 to 21% (+ 4%; 95% CI + 2.6%, + 6.2%); cohort composition differed significantly across phases ( p < 0.001). Comorbidity burden was stable. Overall, 30-day complication rates were low (1.0%). Among Black patients, complication rates declined from 3.9% pre-COVID to 0.8% during recovery (− 3.1%; 95% CI − 5.7%, − 2.1%; p = 0.004). In sensitivity analysis, Black patients had higher odds of complications compared with White patients (OR 3.21; 95% CI 1.55, 6.71; p = 0.002). No individual complication type differed significantly after Benjamini–Hochberg correction. Readmission and reoperation rates did not differ significantly across phases. Conclusions The racial and ethnic composition of adolescents undergoing MBS shifted substantially across the COVID-19 pandemic, with increased representation of historically underserved racial and ethnic groups. Complication disparities observed among Black patients pre-COVID were not statistically significant in later phases, though sparse event counts limit interpretation. Prospective studies are needed to clarify the mechanisms driving pandemic-era changes in equity of access to adolescent MBS.

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