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THE RACIAL, SEX AND SOCIOECONOMIC DIVIDE: AN ASSESSMENT OF THE IMPACT OF DISPARITIES ON OUTCOMES AFTER SURGICAL INTERVENTION FOR MEDICALLY REFRACTORY GASTROPARESIS
Emma Venard
*1, Sven Eriksson
1,3, Inanc Sarici
1,3, Himsikhar Khataniar
4, Margaret Gardner
1, Ping Zheng
1, Shahin Ayazi
1,2,31Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, PA; 2Department of Surgery, Drexel University, Pittsburgh, PA; 3Chevalier Jackson Research Fellowship, Esophageal Institute, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA; 4Department of Medicine, Allegheny Health Network, Pittsburgh, PA
Introduction: Gastroparesis, a gastric motility disorder, predominantly affects female patients, with prior studies reporting racial and socioeconomic status (SES)-linked disparities in etiology and access to treatment. However, data specifically addressing disparities in both the presentation and surgical outcomes of medically refractory gastroparesis remain limited. This study aims to evaluate sex, race, and SES disparities in the presentation and outcomes of surgical intervention for medically refractory gastroparesis.
Methods: Patients undergoing surgery (pyloric drainage or gastric stimulator) for medically refractory gastroparesis were selected. Outcomes were assessed using the gastroparesis cardinal symptom index (GCSI) and resolution of predominant symptoms. A GCSI score ? 4 was considered severe. United States Census Bureau wealth. income, education and occupation data were used to calculate a SES summary score, and categorize patients as low, middle or high SES. Demographic, preoperative clinical and outcome data were compared by age, sex, and SES.
Results: A total of 369 underwent surgical intervention for medically refractory gastroparesis. Of these, 302 (81.8%) were female, 297 (92.9%) Caucasian, 23 (7.1%) African American, and 46 (15.3%) were low SES. Demographics and differences in clinical presentation between groups are shown in
Table 1. At a mean of 10.7 (12) months after surgery GSCI scores improved from 3.1 (2-4) to 2.4 (2-3), p<0.0001, and 74.1% had resolution of symptoms. Outcomes are compared in
Table 2.
Female patients had a lower BMI (p=0.035) and were more likely to present with idiopathic gastroparesis (p=0.011). Male patients had more diabetic gastroparesis (p=0.038).
African American patients were more likely to present with diabetic gastroparesis (p=0.0002), whereas Caucasian patients had more idiopathic gastroparesis (p=0.002). African American also had severe symptoms (p=0.018) with higher GCSI total (p=0.017), vomiting (p=0.008) and satiety scores (p=0.059). After surgery, their symptoms remained more severe (p=0.084) with higher GSCI total (p=0.027), vomiting (p=0.002) and satiety scores p=(0.073).
Low SES patients were younger (p=0.005) and more likely to have diabetic gastroparesis (p=0.038). They also presented with worse gastric emptying (p=0.085). Outcomes were comparable between SES groups.
Conclusions: Sex, racial, and SES factors influence gastroparesis presentation, females more likely to have idiopathic gastroparesis, while and male and low SES patients had more diabetic gastroparesis. African Americans reported more severe symptoms and had worse outcomes. SES did not affect surgical outcomes, though low SES patients had higher gastric retention pre-surgery. These findings highlight the need for targeted strategies to address disparities in the management of medically refractory gastroparesis.
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