Background: Demographic factors influencing complication risks after bariatric surgery remain unclear. We aimed to synthesise findings from relevant studies to investigate these demographic risk factors.
Methods: A rapid review involved searching the Medline database from 2017 to July 2022 for relevant observational studies. The standard inverse variance method was used to combine effect sizes for meta-analysis.
Results: A total of 71 observational studies (69 cohort, 2 case-control) published between 2017 and July 2022 were reviewed. Meta-analysis was considered for 59 studies. Compared to younger adults (<65 years), older adults (≥65 years) had an increased risk of death (Risk Ratio [RR] 2.62, 95%CI: 1.63–4.23; I²: 42.04%, p=0.1512), anastomotic leak (RR 1.64, 95%CI: 1.04–2.58; I²: 61.09%, p=0.0229), haemorrhage (RR 1.51, 95%CI: 1.16–1.97; I²: 35.57%, p=0.0739), and serious complications (excluding death) (RR 1.76, 95%CI: 1.09–2.82; I²: 93.24%, p<0.0001). These results remained mostly robust following sensitivity analyses. Additionally, males had an increased risk of anastomotic leak compared to females (RR 1.39, 95%CI: 1.04–1.87; I²: 72.36%, p=0.0279).
Narrative summary: Eleven out of 26 studies examining race/ethnicity reported higher complication rates among Black/African American patients compared to White American patients. Studies suggested a trend of increased complication risk associated with lower socioeconomic status, including public health insurance, lower income, disability benefits, and being divorced/widowed. Conversely, being single and residing in a medium/small town had a protective effect.
Conclusions: Older age is a consistent risk factor for complications following primary bariatric surgery. Male sex and other sociodemographic factors should also be considered during pre-operative assessment and perioperative planning.