Prevalence and short-term outcomes of primary metabolic and bariatric surgery in non-binary patients: an analysis of the MBSAQIP database.
TL;DR
Non-binary status was independently associated with higher odds of readmission but was not associated with increased adjusted odds of serious complications, which should be interpreted cautiously and support the need for more nuanced gender data collection and long-term outcomes research.
Abstract
INTRODUCTION Non-binary individuals represent a growing demographic in the U.S. and experience higher rates of obesity. Metabolic and bariatric surgery (MBS) is the most effective treatment for patients with severe and complex obesity, yet data on its use and outcomes in non-binary patients have not yet been studied. Existing research has focused on binary gender categories, leaving a critical gap in understanding surgical outcomes for non-binary individuals. This study compared perioperative characteristics and 30-day outcomes of MBS between non-binary and binary patients.
Methods
A retrospective analysis of the 2020-2023 MBSAQIP database included adult patients undergoing primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), stratified by gender identity. Baseline demographics, comorbidities, operative details, and 30-day outcomes were compared. Multivariable logistic regression was used to identify predictors of serious postoperative complications.
Results
Among 692,615 patients, 272 (0.04%) identified as non-binary. Their numbers more than doubled over the study period. Compared to binary cohort, non-binary cohort were younger (37.3 ± 11.1 vs. 43.1 ± 11.8 years, p < 0.0001), had higher BMI (46.7 ± 8.6 vs. 45.1 ± 7.7 kg/m2, p = 0.001), and had higher proportions of obstructive sleep apnea (45.6% vs. 37.2%, p = 0.004). They underwent RYGB more often (32.7% vs. 27.2%, p = 0.040), had longer operative times (91.2 ± 49.2 vs. 84.4 ± 49.2 min, p = 0.004), and higher 30-day readmission rates (6.3% vs. 2.9%, p = 0.001). No significant differences were found in rates of reoperation, leak, bleeding, VTE, or serious complications. Non-binary identity was not an independent predictor of serious complications (OR 0.98, 95% CI 0.46-2.08, p = 0.958). In contrast, non-binary identity independently predicted higher 30-day readmission rates (OR 2.19, 95% CI 1.33-3.59; p = 0.002).
Conclusions
Non-binary patients represented a small but increasing proportion of patients undergoing primary MBS. In this 30-day MBSAQIP analysis, non-binary status was independently associated with higher odds of readmission but was not associated with increased adjusted odds of serious complications. Given the small non-binary cohort and limited readmission-detail availability, these findings should be interpreted cautiously and support the need for more nuanced gender data collection and long-term outcomes research.