Neighborhood Socioeconomic Status and Short-Term Postoperative Complications Following Bariatric Surgery

Background: Obesity is a significant public health concern, affecting over 41.9% of adults in the United States and contributing to increased risk of chronic conditions and premature mortality. Bariatric surgery is the most effective long-term intervention for severe obesity, offering sustained weight loss and improved metabolic outcomes. However, socioeconomic disparities persist in both the utilization and postoperative outcomes of bariatric surgery, particularly among those who live in socioeconomically disadvantaged neighborhoods. Objective: This study evaluates the impact of neighborhood socioeconomic status (nSES), as measured by the Distressed Communities Index (DCI), on short-term postoperative complications following bariatric surgery. Additionally, we investigate whether race/ethnicity moderates this association. Methods: We conducted a retrospective cohort study using data from the Maryland State Inpatient Database (SID) from 2018 to 2020. The study population included adult patients (≥18 years) who underwent bariatric surgery during the study period. The primary outcome was the occurrence of short-term postoperative complications (e.g. gastrointestinal leaks, gastrointestinal bleeding and venous thromboembolism) categorized using a composite complication variable defined as no complications or one or more complication. The primary independent variable was nSES, classified into five categories based on the DCI (prosperous, comfortable, mid-tier, at-risk, and distressed). Multivariable ordinal logistic regression models were used to assess the association between nSES and the occurrence of one or more complication post-surgery, adjusting for demographic, clinical, and socioeconomic and geographic covariates. We tested whether race/ethnicity modified the association between nSES and the selected outcomes. Results: Among 10,784 patients who underwent bariatric surgery in the study period, 94.7% had no postoperative complications, 5.3% experienced one or more complications. The most common complications were venous thromboembolism (2.2%) and gastrointestinal leaks (0.9%). Multivariable analyses revealed no statistically significant association between nSES and the occurrence of short-term postoperative complications. Additionally, race/ethnicity did not significantly moderate this relationship. Conclusions: This study found no significant association between neighborhood socioeconomic disadvantages and the occurrence of short-term postoperative complications following bariatric surgery.