Association of prior metabolic and bariatric surgery with severity of coronavirus disease 2019 (COVID-19) in patients with obesity

Aminian, Ali; Fathalizadeh, Alisan; Tu, Chao; Butsch, W. Scott; Pantalone, Kevin M.; Griebeler, Marcio L.; Kashyap, Sangeeta R.; Rosenthal, Raúl J.; Burguera, Bartolomé; Nissen, Steven E.

doi:10.1016/j.soard.2020.10.026

Cited by 47 publications

(64 citation statements)

References 32 publications

(43 reference statements)

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“…Our literature review yielded 3 retrospective studies [3,20,21] on 9022 unique patients including 590 patients who had a history of prior bariatric surgery (Fig. 1, Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…In the multivariate analysis, prior history of bariatric surgery was associated with a lower hospital admission rate compared with control patients with obesity (OR 0.31 [95% CI 0.11-0.88], P = 0.028). While none of the 4 exploratory outcomes occurred in the bariatric surgery group, 43 (13.0%) patients in the control group required ICU admission (P = 0.021), 22 (6.7%) required mechanical ventilation, 5 (1.5%) required dialysis, and 8 (2.4%) patients died [3].…”

Section: Cleveland Clinic Studymentioning

confidence: 96%

“…Similarly, of the 21 (63.6%) patients who had hypertension at the time of bariatric surgery, 9 patients were not on antihypertensive medications at the time of a positive viral test. In patients with a history of hypertension, the median number of antihypertensive medications decreased from 2 at the time of bariatric surgery to 1 at the time of positive viral test (P = 0.001) [3].…”

Section: Cleveland Clinic Studymentioning

confidence: 98%

“…There is a large body of evidence indicating obesity, diabetes, hypertension, and related cardiovascular conditions worsen the clinical outcomes of coronavirus disease 2019 (COVID-19) including a higher rate of hospitalization, need for mechanical ventilation, and mortality [1][2][3]. There are several physiological explanations for poor clinical outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with severe obesity.…”

Section: Introductionmentioning

confidence: 99%

“…Many patients with obesity and metabolic disease suffer from different cardiovascular, pulmonary, renal, and liver diseases that can worsen the clinical outcomes of COVID-19. In addition, mechanical effects of excess fat on the function of the chest wall, diaphragm, and lung may contribute to the severity of clinical status of patients with obesity after developing COVID-19 pneumonia [1][2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Association of Bariatric Surgery with Clinical Outcomes of SARS-CoV-2 Infection: a Systematic Review and Meta-analysis in the Initial Phase of COVID-19 Pandemic

Aminian

2021

OBES SURG

Self Cite

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“…Our literature review yielded 3 retrospective studies [3,20,21] on 9022 unique patients including 590 patients who had a history of prior bariatric surgery (Fig. 1, Table 1).…”

Section: Resultsmentioning

confidence: 99%

Section: Cleveland Clinic Studymentioning

confidence: 96%

Section: Cleveland Clinic Studymentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Association of Bariatric Surgery with Clinical Outcomes of SARS-CoV-2 Infection: a Systematic Review and Meta-analysis in the Initial Phase of COVID-19 Pandemic

Aminian

2021

OBES SURG

Self Cite

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Association of Weight Loss Achieved Through Metabolic Surgery With Risk and Severity of COVID-19 Infection

Aminian

Milinovich

et al. 2022

JAMA Surg

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IMPORTANCEObesity is an established risk factor for severe COVID-19 infection. However, it is not known whether losing weight is associated with reduced adverse outcomes of COVID-19 infection.OBJECTIVE To investigate the association between a successful weight loss intervention and improved risk and severity of COVID-19 infection in patients with obesity. DESIGN, SETTING, AND PARTICIPANTSThis cohort study involved adult patients with a body mass index of 35 or higher (calculated as weight in kilograms divided by height in meters squared) who underwent weight loss surgery between January 1, 2004, and December 31, 2017, at the Cleveland Clinic Health System (CCHS). Patients in the surgical group were matched 1:3 to patients who did not have surgical intervention for their obesity (control group). The source of data was the CCHS electronic health record. Follow-up was conducted through March 1, 2021.EXPOSURES Weight loss surgery including Roux-en-Y gastric bypass and sleeve gastrectomy. MAIN OUTCOMES AND MEASURES Distinct outcomes were examined before and after COVID-19 outbreak on March 1, 2020. Weight loss and all-cause mortality were assessed between the enrollment date and March 1, 2020. Four COVID-19-related outcomes were analyzed in patients with COVID-19 diagnosis between March 1, 2020, and March 1, 2021: positive SARS-CoV-2 test result, hospitalization, need for supplemental oxygen, and severe COVID-19 infection (a composite of intensive care unit admission, need for mechanical ventilation, or death). RESULTS A total of 20 212 patients (median [IQR] age, 46 [35-57] years; 77.6% female individuals [15 690]) with a median (IQR) body mass index of 45 (41-51) were enrolled. The overall median (IQR) follow-up duration was 6.1 (3.8-9.0) years. Before the COVID-19 outbreak, patients in the surgical group compared with control patients lost more weight (mean difference at 10 years from baseline: 18.6 [95% CI,] percentage points; P < .001) and had a 53% lower 10-year cumulative incidence of all-cause non-COVID-19 mortality (4.7% [95% CI, 3.7%-5.7%] vs 9.4% [95% CI, 8.7%-10.1%]; P < .001). Of the 20 212 enrolled patients, 11 809 were available on March 1, 2020, for an assessment of COVID-19-related outcomes. The rates of positive SARS-CoV-2 test results were comparable in the surgical and control groups (9.1% [95% CI, 7.9%-10.3%] vs 8.7% [95% CI, 8.0%-9.3%]; P = .71). However, undergoing weight loss surgery was associated with a lower risk of hospitalization (adjusted hazard ratio [HR], 0.51; 95% CI, 0.35-0.76; P < .001), need for supplemental oxygen (adjusted HR, 0.37; 95% CI, 0.23-0.61; P < .001), and severe COVID-19 infection (adjusted HR, 0.40; 95% CI, 0.18-0.86; P = .02).CONCLUSIONS AND RELEVANCE This cohort study found that, among patients with obesity, substantial weight loss achieved with surgery was associated with improved outcomes of COVID-19 infection. The findings suggest that obesity can be a modifiable risk factor for the severity of COVID-19 infection.

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History of bariatric surgery and COVID‐19 outcomes in patients with type 2 diabetes: Results from the CORONADO study

Blanchard

Perennec

Smati

et al. 2022

Obesity

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Objective This study assessed the impact of a history of metabolic and bariatric surgery (MBS) on the clinical outcomes in patients with type 2 diabetes (T2D) and severe obesity hospitalized for COVID‐19. Methods In this post hoc analysis from the nationwide observational CORONADO (Coronavirus SARS‐CoV2 and Diabetes Outcomes) study, patients with T2D and a history of MBS were matched with patients without MBS for age, sex, and BMI either at the time of MBS or on admission for COVID‐19. The composite primary outcome (CPO) combined invasive mechanical ventilation and/or death within 7 and 28 days following admission. Results Out of 2,398 CORONADO participants, 20 had a history of MBS. When matching for BMI at the time of MBS and after adjustment for diabetes duration, the CPO occurred less frequently within 7 days (3 vs. 17 events, OR: 0.15 [0.01 to 0.94], p = 0.03) and 28 days (3 vs. 19 events, OR: 0.11 [0.01 to 0.71], p = 0.02) in patients with MBS (n = 16) vs. controls (n = 44). There was no difference in CPO rate between patients with MBS and controls when matching for BMI on admission. Conclusions These data are reassuring regarding COVID‐19 prognosis in patients with diabetes and a history of MBS compared with those without MBS.

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Association of prior metabolic and bariatric surgery with severity of coronavirus disease 2019 (COVID-19) in patients with obesity

Cited by 47 publications

References 32 publications

Association of Bariatric Surgery with Clinical Outcomes of SARS-CoV-2 Infection: a Systematic Review and Meta-analysis in the Initial Phase of COVID-19 Pandemic

Association of Bariatric Surgery with Clinical Outcomes of SARS-CoV-2 Infection: a Systematic Review and Meta-analysis in the Initial Phase of COVID-19 Pandemic

Association of Weight Loss Achieved Through Metabolic Surgery With Risk and Severity of COVID-19 Infection

History of bariatric surgery and COVID‐19 outcomes in patients with type 2 diabetes: Results from the CORONADO study

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