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Background <p>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.</p> Methods <p>Using MBSAQIP, we identified adolescents aged 19&#xa0;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.</p> Results <p>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 (<i>p</i> &lt; 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%; <i>p</i> = 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; <i>p</i> = 0.002). No individual complication type differed significantly after Benjamini–Hochberg correction. Readmission and reoperation rates did not differ significantly across phases.</p> Conclusions <p>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.</p> Graphical Abstract <p></p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月16日

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  • Nikita S. Thareja,
  • Ana Garcia Cabrera,
  • J. Jeffery Reeves,
  • Hannah M. Hollandsworth,
  • Bryan J. Sandler,
  • Garth R. Jacobsen,
  • Ryan C. Broderick

摘要

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.

Graphical Abstract