Gender differences among bariatric patients and evaluation of outcome

Background: Gender disparities in bariatric surgery utilization and outcomes remain underexplored despite growing evidence of sex-specific risk profiles. This study aimed to evaluate gender-based differences in preoperative characteristics and short-term postoperative outcomes among patients undergoing bariatric surgery in the National Surgical Quality Improvement Program (NSQIP) cohort. Methods: A retrospective analysis was performed on 157,201 patients who underwent bariatric surgery, utilizing data from the American College of Surgeons-NSQIP database. Demographic, clinical, laboratory, and operative variables were compared between male and female patients. Primary outcomes included 30-day mortality and major postoperative complications, encompassing cardiac, respiratory, urinary, thromboembolic, septic, and bleeding events. Statistical analyses were conducted using SAS software, version 9.4 (SAS Institute Inc., Cary, NC, USA). Results: Male patients comprised 20.48% of the cohort and presented with significantly higher body mass index, older age, and greater prevalence of diabetes, hypertension, chronic obstructive pulmonary disease, and renal dysfunction. Laboratory markers indicated more advanced hepatic and hematologic abnormalities in males. Postoperative outcomes revealed a threefold higher mortality rate in males (0.15% vs. 0.05%, P < 0.0001), along with significantly increased rates of cardiac (0.19% vs. 0.07%), respiratory (0.51% vs. 0.31%), urinary (0.32% vs. 0.09%), thromboembolic (0.46% vs. 0.36%), septic (0.47% vs. 0.33%), and bleeding complications (0.76% vs. 0.55%). Return to the operating room was also more frequent in males (1.37% vs. 0.99%, P < 0.0001). Conclusions: Male patients undergoing bariatric surgery exhibit a higher burden of comorbidities and significantly worse short-term outcomes, including mortality and major complications. These findings underscore the need for earlier referral, targeted preoperative optimization, and gender-sensitive perioperative strategies to improve safety and equity in bariatric care.