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1st Kuwait National Bariatric Registry Report

Kuwait publishes 1st National Bariatric Registry Report

Based on the World Health Organization (WHO) data, Kuwait has the second highest prevalence of obesity at 38.3% in the Arabian Gulf
Report demonstrates that bariatric procedures in Kuwait are safe for patients with a 0.0% reported in-hospital operative mortality rate

The State of Kuwait Ministry of Health and Dendrite Clinical Systems, in conjunction with Bader Sultan & Brothers Company, are delighted to announce the publication of the First Kuwait National Bariatric Registry Report 2019, the first ever national report on bariatric and metabolic surgery in the Arabian Gulf region. This inaugural report, which includes 3,302 bariatric surgery cases, contains data on baseline obesity-related disease, operation types, operative outcomes and disease status after bariatric surgery in Kuwait.

Dr Salman Al-Sabah

“This national report that is the first of its kind has the potential to help the bariatric community establish essential benchmark knowledge about the patients we are operating upon, their age and gender distributions, body mass index (BMI) and comorbidity disease burden, as well as track trends in surgery over time,” said co-author of the report, Dr Salman Al-Sabah (Chairman of Surgery, Jaber Al-Ahmad Al-Sabah Hospital, Kuwait President of the Kuwait Association of Surgeons President of the Gulf Obesity Surgery Society American College of Surgeons, Governor, Kuwait Assistant Professor of Surgery, Kuwait University). “With the increasing frequency of bariatric procedures performed in Kuwait and Kuwait ranked as one of the highest countries for the frequency of bariatric surgeries performed, it is important to collect this growing body of data into national registries.”

The Kuwait National Bariatric Registry currently comprises data being submitted from six public hospitals (Al Adan Hospital, Al Amiri Hospital, Farwaniya Hospital, Jahra Hospital, Mubarak Al-Kabeer Hospital and Al Sabah Hospital) by 63 surgeons. Of the 3,302 cases some 2,704 were primary procedures (81.9% of operation records), 411 were subsequent or revision operations (12.4%) and 187 were gastric balloon placements (5.7%). Remarkably, 87% of entries for patients having their primary operation had either no missing data or one missing data-item amongst a list of ten obesity-related disease assessed pre-operatively (these related conditions included: type 2 diabetes, back or leg pain, depression, impaired functional status, gastro-oesophageal reflux, raised blood pressure,  dyslipidaemia, liver disease, sleep apnoea and increased risk of deep vein thrombosis or pulmonary embolism.

Key patient outcomes from the report showed:

  • At the time of primary surgery, 73.6% of all patients are female; this is in line with results from bariatric surgery registries from across the world; comparison to data from the IFSO Global Registry shows that the proportion of female patients in Kuwait is right in the middle of the ordered distribution of countries that contributed.
  • In Kuwait the patients have surgery at a younger age than most other countries; on average Kuwaiti patients are 32.6 years old at the time of their operation.
  • Patients in Kuwait have a slightly higher BMI than the average reported from the IFSO Global Registry; the average BMI for a male Kuwaiti patient was 45.9 and for the average female patients it was 43.3.
  • There is a significant burden of obesity-related disease in Kuwait: only 1.8% of men and 2.0% had no reported conditions, a minority of patients had six or more obesity-related diseases (6.5% of men and 3.6% of women), with most patients having between one and five conditions (91.7% of men and 94.4% of women).
  • Over 90% of patients had impaired functional status pre-operatively.
  • 66.0% of the men and 60.1% of the women had liver disease.
  • Almost one-quarter of Kuwaiti patients had back or leg pain related to their weight (24.1% of the men and 23.9% of the women).
  • There were a large number of patients with type 2 diabetes (16.4% of the men and 12.3% of the women), which is a significant burden for the country’s healthcare system.
  • The rates of obesity-related disease tended to be higher for male patients.

Key surgical outcomes from the report included:

  • The reported post-operative, in-hospital mortality rate was 0.0%.
  • Most operations in Kuwait were sleeve gastrectomy procedures (93.7% of primary surgery), one anastomosis gastric bypass/mini gastric bypass was the next most commonly recorded operation (2.9%) and then Roux en Y gastric bypass (2.3%).
  • In line with current accepted practice, almost all primary surgery was performed laparoscopically; only one operation was reported as having been converted to an open procedure.
  • 6.5% of patients had an additional procedure in concert with their bariatric surgery (2.9% cholecystectomy; 2.8% hernia repair; 0.1% liver biopsy; 0.9% another kind of minor procedure)
  • Operative complication rates were low: 1.5% of patients had a related bleed (3.6% after Roux en Y gastric bypass) and 0.1% had a staple line leak.
  • Post-operative complications were also rare, considering the patients’ rates of obesity-related disease pre-operatively: 5.1% has a cardio-vascular complication; the majority of these complications were dysrhythmias. 7.4% had another complication (almost half were simply vomiting or poor intake after the surgery)
  • Half of patients had been discharged home a little after two days post-surgery; patients who had a gastric band placed went home much sooner (60% were discharged by one day after surgery) and the patients who had a Roux en Y gastric bypass stayed a little longer (60% of these patients were discharged by post-operative day three).

Dr Basel Hamoud Al-Sabah

“It is with great pleasure that I commend this First Report of the National Bariatric Surgery Database made available by Dendrite Clinical Systems. This National Bariatric Surgery Database initiative is the first of its kind in the State of Kuwait. It has the potential to help the bariatric community establish essential benchmark knowledge and outcomes about patients and the burden of comorbidities as well as track national trends in surgery over time…There are only a few countries in the world that have the capability to have a unified registry under one network. Many countries maintain hospital-based registries. Even fewer countries have national databases,” His Excellency, Dr Basel Hamoud Al-Sabah, Minister of Health, Kuwait, writes in the report. “…Therefore, we are very proud that we now have a national registry established under one network for all the government hospitals in Kuwait. We hope in the future we can collect more data, especially on follow-up, which is of great importance and can successfully transform this project to similar other projects in the country so we can have a better knowledge of what is happening in our health system, and we can act upon to reduce the burden of disease.”

It is hoped that as the Kuwait National Bariatric Registry continues it will accumulate more data so researchers can examine trends over time. Moreover, once the registry begins collecting and reporting on follow up data, it will be able to demonstrate that patients benefit from bariatric surgery, losing weight and seeing resolution of their obesity-related disease. Finally, it also remains a goal for the future to incorporate data from all the key stakeholders in bariatric surgery - especially surgeons and physicians - to have them embrace this data collection and reporting process at all individual government and private clinics and hospitals throughout Kuwait.

“We are delighted to publish this first report and I would like to thank all the contributors for submitting their data,” said Dr Peter Walton, Managing Director of Dendrite. “This report clearly demonstrates the safety and effectiveness of bariatric and metabolic surgery for treating patients with obesity in Kuwait. I hope this report will be the first in a series of ground-breaking reports that will record and analyse clinical data, and help improve patient outcomes.”

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