Social Determinants of Weight Loss Following Transoral Outlet Reduction (TORe) at a Safety-Net Hospital

Introduction: Roux-En-Y gastric bypass (RYGB) is a bariatric surgery for weight loss (WL) among obese patients. Weight regain (WR) is a common complication of RYGB. One anatomic etiology of WR after RYGB is dilation of the gastrojejunal (GJ) anastomosis outlet. Transoral Outlet Reduction (TORe) is an endoscopic therapy using a full thickness endoscopic suturing device to narrow the GJ outlet. Given the novelty of bariatric endoscopy, most insurance does not cover the cost. There is little data on outcomes of bariatric endoscopy in underserved populations. Our study aimed to assess the impact of socioeconomic and demographic factors on WL after TORe at our safety net hospital. Methods: We performed a retrospective chart review of patients who underwent TORe for post-RYGB WR from November 2016 to September 2020. Data collected included age, gender, ethnicity, highest education level, income, marital status, insurance status, number of children and procedural outcomes (weight, metabolic parameters). We performed a multivariable linear regression analysis using R© software to assess the relationship of social factors to TORe outcomes. Results: We analyzed 45 TORe procedures. The cohort was predominantly female (98%) with a mean age of 42 years. Of the 45 TORes, 7 were performed in Black patients, 31 Hispanic, 3 Asian, 1 White and 3 in patients of unknown ethnic background. Thirty-one (69%) TORes were in patients with annual household incomes of less $50,000 and 22 (49%) with only a high school level education. Thirty-five (67%) procedures were performed in patients who were unmarried and 32 (71%) procedures were performed in patients with insurance. The mean diameter of the pre-TORe GJ outlet was 27.5 mm. Mean weight lost post-TORe was 12.5 lbs which corresponded to a 5.7% WL and 3.5% reduction in BMI. Compared to an annual income of less than $10,000, a patient with an annual income of $10,000-$50,000 would be 3.87 times as likely to have post-TORe per lb WL (p=0.15), and 4.50 times as likely to with an annual income of $50,000-$100,000 (p=0.26). We also found that having insurance made it 2.75 times as likely to promote post-TORe per lb WL compared to being uninsured (p=0.313). Conclusion: Social determinants of health are known to impact obesity and post-operative outcomes in bariatric surgery patients. We found in our analysis of an underserved bariatric population at our public hospital that a higher income and having insurance was positively associated with better post-TORe WL.Table 1.: Multivariable linear regression analysis of social determinants of post-TORe weight loss; Income 1: less than $10,000; Income 2: $10,000-$50,000; Income 3: $50,000-%100,000.