Background

Although the American Society of Anesthesiologists' (ASA) classification is commonly used to grade preoperative health of surgical patients, it is a subjective assessment potentially subject to bias. Bariatric patients assigned to higher ASA classifications are more likely to have elective surgery denied or delayed, adversely impacting surgical access. This study objective was to determine whether racial disparities are present in the assignment of ASA classification of operative risk.

Methods

From the 2015-2018 MBSAQIP database, we identified patients who underwent sleeve gastrectomy or laparoscopic gastric bypass surgery. Demographic information and comorbidities were compared among racial subgroups (white, black, or Hispanic), stratified by ASA classification.

Results

Of 605,194 patients who met study criteria, 67.5% were white, 18.8% black, and 13.7% Hispanic. 22.5% were ASA class 1-2, 74.1% ASA class 3, and 3.3% ASA class 4-5. At every level of ASA class, white patients were older (ratio of mean [ROM] range = 1.044-1.092, p<0.001) (Fig.1A) with a significantly higher number of comorbidities (ROM range = 1.067-1.595, p<0.001) (Fig.1B) than patients of color. This included a higher preponderance of MI, HLD, GERD, OSA, smoking and DVT/PE (p>0.001).

Conclusions

In this analysis of ASA classification of bariatric patients, white patients were significantly more likely to be placed in a lower ASA class than black or Hispanic patients with similar comorbidities. This may represent a barrier to bariatric surgery for patients of color not present for white patients. Preoperative evaluation of bariatric patients should make use of objective criteria to more impartially estimate operative risk.