73.6% of all patients were seen to be female. The average age for participants was 32.6 years, with the average age for male patients being 32.6 years; and for female patients 32.6 years. The majority of patients were under the age of 35 years and this can be accounted for by the fact that Kuwait has a generally younger population compared to the rest of world. In addition, the national policy stipulates that patients over 65 may not be offered this kind of intervention (Table 2). The average preoperative BMI was 45.9 kg/m2 for male patients and 43.3 kg/m2 for female patients (Fig. 1a). The distribution of BMI was further sub-divided by hospital, which can be seen in Fig. 1b.
Obesity Related Diseases
The Kuwait National Bariatric Surgery Registry records the status of 10 obesity-related diseases for each patient. These 10 obesity-related diseases are: Type 2 diabetes; Back pain or leg pain; Depression; Impaired functional status; Gastro-esophageal reflux disorder (GERD); Hypertension; Dyslipidemia; Liver disease; Sleep apnea; Increased risk of deep vein thrombosis (DVT) or pulmonary embolus (PE)
As shown in the table 4 and figure 3, male bariatric surgery patients in Kuwait tend to have higher rates of obesity-related disease. 16.4% of males and 12.3% of females presented with type 2 diabetes, while the most prevalent obesity related disease was seen to be a poor functional status in both males and females (90.8% and 90.5%, respectively). Interestingly, rates of medication for depression are very low in absolute terms.
Obesity Surgery Mortality Risk Score
Table 4 demonstrates the OSMRS for our population in Kuwait. The average OSMRS is obviously higher for the male patients (1.70 versus 0.54 for the female patients) as male gender is a component of the scoring system itself. However, very few patients fall in group C (3.0% of male patients and 0.4% of female patients).
The vast majority of procedures performed in Kuwait are sleeve gastrectomy, which reflects current global trends; single anastomosis gastric bypass (OAGB / MGB) is the second most common procedure. When looking at revisional surgeries, a single anastomosis gastric bypass has mainly been performed as a subsequent procedure, most commonly after a sleeve gastrectomy (Figure 3, Table 5).
The majority of these procedures are carried out laparoscopically, constituting 94% of the procedures. Open procedures are very rare (0.1%) and this approach is generally only employed in a small minority of revisional procedures (Table 6). This is all in line with current practice across the world. Staple line reinforcements were used in 55.6% of the cases, with the majority being TRS reinforcements (26.2%). Moreover, the majority of surgeons (83.6%) used a 36 Fr bougie for their operations.
Gallbladder and hernia repair were the most common additional procedures performed at the time of bariatric procedures (Table 7)
The most encountered in-hospital complication after primary bariatric surgery was seen to be bleeding (1.5%). When it came to looking at post-operative complications, Roux-en-Y gastric bypass has the highest recorded rate of post-operative complications, with 3.6% of patients presenting with bleeding.
On average most patients were discharged home within 2-3 days after their bariatric procedure.
Patients tend to go home sooner after a gastric band procedure (over 50% discharged by post-operative day 1) than after undergoing other procedures (Figure 4).
The overall rate of operative complications was seen to be 2.6%. The highest rate of operative complications was after Roux en Y gastric bypass (10.3%; 29 patients) and the lowest after sleeve gastrectomy (2.5%; 61 patients).
Furthermore, this report demonstrates that bariatric procedures in Kuwait are safe for patients with a 0.0% reported in-hospital operative mortality rate. The major cardiac complication encountered post-operatively was Dysrhythmia, encountered in 15.5% of patients, with the majority (9.5%) seen in post Roux-en-Y patients. The only other major complication encountered was vomiting/poor intake post-operatively, seen in 18.9% of patients. This can be seen in Table 9.