Surgery for obesity: India versus usa - a snapshot perioperative care comparison at two centers

Background: Surgery to treat obesity is becoming more accepted globally. The surgical expertise available in India is helpful to Indian citizens and patient visitors to India because of cost competitiveness. This report provides perioperative outcomes including cost of bariatric surgery in India versus U.S.A. Patients & Methods: During 2006, 200 consecutive bariatric patients in Mumbai and Minneapolis were studied. All received general Anaesthesia for their procedures. Their preoperative morbidity, intraoperative care, early postoperative outcome and costs were compared. Results: The BMI was similar (India 48.3 ± 7.8; U.S.A. 48.3 ± 8.5). In the U.S.A. more patients were hypertensive (53 vs. 37 p =0.033) and likely to be female (80% vs. 60% p =0.032). Multiple co-morbidities were more likely in men in both countries. Laparoscopic roux-en-y gastric bypass (LRYGB) was the more common procedure in U.S.A. (85 vs. 69 p =0.012) with a higher trend to perform the laparoscopic adjustable gastric banding (LAGB) in India with a significantly higher likelihood of the LAGB needing revision (0 vs. 7 p =0.014). The LAGB took half the time in India (42.8 ± 18 vs. 80.5 ± 20 mins p =0.0001) with the majority being cared for with a proseal LMA (14 vs. 0 p =0.0002). All were intubated for LRYGB with the majority done using a rapid sequence technique in the U.S.A. (45 vs. 0 p =0.0001). Patients with an anticipated difficult airway were handled differently in India vs. U.S.A. The procedure was four times more costly in the U.S.A. ($32000 vs. $8000).