Disparities in presentation and outcomes after surgery for medically refractory gastroparesis: the impact of demographic and socioeconomic status

BACKGROUND: Gastroparesis is a debilitating disorder, and surgical therapy can provide meaningful improvement in patients who remain symptomatic despite medical treatment. However, patients often present with variable disease severity, and the influence of demographic and socioeconomic factors on this variability and on postoperative outcomes remains poorly defined. This study aimed to evaluate the effect of demographic status and socioeconomic status (SES) on preoperative characteristics and postoperative outcomes in patients who underwent surgery for medically refractory gastroparesis. METHODS: All patients who underwent surgical treatment of medically refractory gastroparesis between 2012 and 2024 at a tertiary foregut center were retrospectively analyzed. Demographics, gastroparesis etiology, gastric emptying, and Gastroparesis Cardinal Symptom Index (GCSI) scores were compared across sex, race, age, and SES groups. SES classification was derived from zip code-level United States census data. Surgical procedures included pyloroplasty, gastric peroral endoscopic pyloromyotomy, and gastric electrical stimulation. RESULTS: A total of 387 patients were included (82.4% female; mean age of 51.3 ± 15.6 years). Idiopathic (62.3%) and diabetic (23.9%) etiologies predominated. Overall, GCSI total score improved significantly (median: 3.1 [IQR, 2.5-3.9] to 2.4 [IQR 1.6-3.3]; P