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Surgical Endoscopy

Published in:

07-11-2023

Comparison of Eastern and Western patients undergoing bariatric surgery at two US and Korean institutions: a retrospective analysis of differing bariatric patient populations

Authors: Zachary N. Weitzner, Ki Hyun Kim, Yoonhong Kim, Kyung Won Seo, Young Sik Choi, Erik P. Dutson

Published in: Surgical Endoscopy | Issue 1/2024

Abstract

Background

Currently, there are differences in both demographics and indications for bariatric surgery between Eastern and Western countries. We compared postoperative outcomes between Korean and American bariatric programs in order to assess how bariatric surgery differently affects these populations.

Methods

We enrolled 540 patients who underwent bariatric surgery at University of California, Los Angeles (UCLA) and 85 patients who underwent surgery at Kosin University Gospel Hospital (KUGH) between January 2019 and December 2020. We compared demographics, complications, weight loss, and metabolic parameters between these groups.

Results

There was a difference in age between the UCLA and KUGH patient groups (44.3 years vs 37.6 years, P < 0.01). Frequencies of T2DM and OSA were also different (4.2% vs 50.6%, 34.1% vs 85.9% P < 0.01. Length of hospital stay varied (1.55 days vs 6.68 days, P < 0.01), but there was no difference in operating time and complications. There was no difference in percent of excess weight loss between the two groups at 6 months (29.7 vs 33.8, P = 0.13). Hepatic steatosis index (HSI) was higher in the UCLA group both before (54.2 vs 51.5, P < 0.01) and after (44.4 vs 40.0, P = 0.02) surgery. LSG was the most frequently performed operation, and robotic surgery and revisions were performed only in the UCLA program.

Conclusion

There were differences in age, BMI, length of stay, and choice of operation between Korean and American bariatric patients. Also, there were differences in the degree of fatty liver disease using HSI and liver enzymes before and after surgery. There was no significant differences in operation time and complications. These findings suggest differences in bariatric practices and reactions to bariatric surgery in Eastern and Western settings.

Graphical abstract

Buchwald H, Williams SE (2004) Bariatric surgery worldwide 2003. Obes Surg 14(9):1157–1164CrossRefPubMed

Lee SK (2015) Current status of laparoscopic metabolic/bariatric surgery in Korea. J Minim Invasive Surg 18(3):59–62CrossRef

Choi YB (2016) Current status of bariatric and metabolic surgery in Korea. Endocrinol Metab (Seoul) 31(4):525–532. https://doi.org/10.3803/EnM.2016.31.4.525CrossRefPubMed

Yoo HM, Kim J-H, Lee SK (2019) Metabolic and bariatric surgery accreditation program and national health insurance system in Korea. J Minim Invasive Surg 22(3):91–100CrossRefPubMedPubMedCentral

Ohta M et al (2019) Bariatric/metabolic surgery in the Asia-Pacific region: APMBSS 2018 survey. Obes Surg 29(2):534–541CrossRefPubMed

Eisenberg D et al (2023) 2022 American society of metabolic and bariatric surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. Obes Surg 33(1):3–14. https://doi.org/10.1007/s11695-022-06332-1CrossRefPubMed

Lee J-H et al (2010) Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis 42(7):503–508CrossRefPubMed

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205CrossRefPubMedPubMedCentral

Sateia MJ (2014) International classification of sleep disorders. Chest 146(5):1387–1394CrossRefPubMed

10.

Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14(6):540–545. https://doi.org/10.1093/sleep/14.6.540CrossRefPubMed

11.

Chung F et al (2016) STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest 149(3):631–638. https://doi.org/10.1378/chest.15-0903CrossRefPubMed

12.

Aly S, Hachey K, Pernar LIM (2020) Gender disparities in weight loss surgery. Mini-invasive Surg 4:21

13.

Information Committee of Korean Society of Bariatric and Metabolic Surgery, Lee HJ et al (2016) Nationwide survey on bariatric and metabolic surgery in Korea: 2003-2013 results. Obes Surg 26(3):691–695CrossRef

14.

American Society for Metabolic and Bariatric Surgery (2021) Metabolic and bariatric surgery fact sheet. https://asmbs.org/resources/metabolic-and-bariatric-surgery. Accessed 10 Oct 2023

15.

Yoon K-H et al (2006) Epidemic obesity and type 2 diabetes in Asia. Lancet 368(9548):1681–1688CrossRefPubMed

16.

Park YS, Ahn S-H, Park DJ, Kim H-H (2018) Effectiveness of sleeve gastrectomy for metabolic surgery in Korea. J Obes Metab Syndr 27(3):131CrossRefPubMedPubMedCentral

17.

Heo Y (2021) Evolution of metabolic surgery in Korea. Foregut Surg 1(2):23–33CrossRef

18.

Hnin K et al (2018) The impact of ethnicity on the prevalence and severity of obstructive sleep apnea. Sleep Med Rev 41:78–86CrossRefPubMed

19.

Clark-Sienkiewicz SM et al (2021) Racial differences in psychological symptoms and eating behaviors among bariatric surgery candidates. J Racial Ethn Health Disparities 8(1):94–98CrossRefPubMed

20.

Wood M, Carlin A, Ghaferi A (2019) Association of race with bariatric surgery outcomes. JAMA Surg 154(5):e190029CrossRefPubMedPubMedCentral

21.

Ivezaj V et al (2019) Racial comparisons of postoperative weight loss and eating-disorder psychopathology among patients following sleeve gastrectomy surgery. Obesity 27(5):740–745CrossRefPubMed

22.

Kim HJ, Madan A, Fenton-Lee D (2014) Does patient compliance with follow-up influence weight loss after gastric bypass surgery? A systematic review and meta-analysis. Obes Surg 24(4):647–651CrossRefPubMed

23.

Spaniolas K et al (2016) Postoperative follow-up after bariatric surgery: effect on weight loss. Obes Surg 26(4):900–903CrossRefPubMed

24.

Reiber BM et al (2021) Weight loss results and compliance with follow-up after bariatric surgery. Obes Surg 31(8):3606–3614CrossRefPubMedPubMedCentral

25.

Tiikkainen M et al (2004) Effects of rosiglitazone and metformin on liver fat content, hepatic insulin resistance, insulin clearance, and gene expression in adipose tissue in patients with type 2 diabetes. Diabetes 53(8):2169–2176CrossRefPubMed

26.

Musso G et al (2010) A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease. Hepatology 52(1):79–104CrossRefPubMed

27.

Mazhar SM, Shiehmorteza M, Sirlin CB (2009) Noninvasive assessment of hepatic steatosis. Clin Gastroenterol Hepatol 7(2):135–140CrossRefPubMed

28.

Li H et al (2010) Fibroblast growth factor 21 levels are increased in nonalcoholic fatty liver disease patients and are correlated with hepatic triglyceride. J Hepatol 53(5):934–940CrossRefPubMed

29.

Willey JZ et al (2011) Race-ethnic differences in the association between lipid profile components and risk of myocardial infarction: the Northern Manhattan study. Am Heart J 161(5):886–892CrossRefPubMedPubMedCentral

30.

Frank AT et al (2014) Racial/ethnic differences in dyslipidemia patterns. Circulation 129(5):570–579CrossRefPubMed

31.

Samji NS et al (2020) Racial disparities in diagnosis and prognosis of nonalcoholic fatty liver disease. Clin Liver Dis 16(2):66CrossRef

32.

Lear SA, Gasevic D (2019) Ethnicity and metabolic syndrome: implications for assessment, management and prevention. Nutrients 12(1):15CrossRefPubMedPubMedCentral

33.

Budiman A (2021) Koreans in the U.S. fact sheet. Pew Research Center’s Social & Demographic Trends Project. https://www.pewresearch.org/social-trends/fact-sheet/asian-americans-koreans-in-the-u-s/. Accessed 27 May 2022

34.

Ko H (2020) Moral hazard effects of supplemental private health insurance in Korea. Soc Sci Med 265:113325CrossRefPubMed

Title: Comparison of Eastern and Western patients undergoing bariatric surgery at two US and Korean institutions: a retrospective analysis of differing bariatric patient populations
Authors: Zachary N. Weitzner
Ki Hyun Kim
Yoonhong Kim
Kyung Won Seo
Young Sik Choi
Erik P. Dutson
Publication date: 07-11-2023
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 1/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-023-10549-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of Eastern and Western patients undergoing bariatric surgery at two US and Korean institutions: a retrospective analysis of differing bariatric patient populations

Abstract

Background

Methods

Results

Conclusion

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Graphical abstract

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