The association between body mass index and perioperative outcomes by ethnicity and socioeconomic status: a systematic review of systematic reviews.

Authors

Olasunkanmi Oyolola, Amanda Daley, Joanna McLaughlin, Gavin Murphy, Katelynn Slade, Henrietta Graham, Tom Abbott, Andrew Issa, Claire Madigan

Published in

Ethnicity & health. Pages 1-21. Oct 14, 2026. Epub Oct 14, 2026.

Abstract

Body mass index (BMI) is associated with adverse perioperative outcomes. This study investigated the completeness of ethnicity and socioeconomic status (SES) reporting in perioperative research and the association between BMI and perioperative outcomes by ethnicity and SES.
We extended a previous systematic review of reviews that compared perioperative outcomes by BMI categories. For this review, we extracted primary studies published from 2004 onwards from included systematic reviews that focused on seven frequently performed surgeries with some evidence of ethnic disparities: total hip arthroplasty, total knee arthroplasty, coronary artery bypass grafting, caesarean section, prostatectomy, breast reconstruction postmastectomy, and gynaecological surgery. We calculated the number (%) of primary studies reporting ethnicity and/or SES and extracted data for perioperative outcomes up to 90 days postoperatively by ethnicity and SES. Outcomes were based on the Standardised Endpoints in Perioperative Medicine initiative. Effect measures and incidence (%) were qualitatively summarised due to heterogeneity in reporting.
From 49 systematic reviews, 332 primary studies investigated the seven surgical procedures and only 39 (11.7%) reported ethnicity (10.8%) or SES (2.4%) at baseline. Among these, only 10 studies (3%) stratified perioperative outcomes by ethnicity and/or SES, with most adjusting for BMI in regression models. Only one study clearly stratified outcomes across BMI categories within each ethnicity. There was some evidence of increasing risk of postoperative atrial fibrillation by ethnicity and BMI. Two studies found that Black patients had higher odds of pulmonary embolism than White patients after adjusting for BMI. Findings for other outcomes and SES were inconsistent.
Poor reporting of ethnicity and SES data limits understanding of how these variables modify the association between BMI and perioperative outcomes. Deliberate inclusion of ethnicity and SES data in study design, analysis, and reporting is needed to address inequality in perioperative research.

PMID:
42874060
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.

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