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, Ali; Tu, Chao

doi:10.1007/s11695-020-05213-9

Cited by 22 publications

(33 citation statements)

References 21 publications

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“…Patients with prior bariatric surgery had a lower rate of hospitalization, no need for ICU or IMV, and no mortality [ 31 ]. These results were further confirmed by a recently published meta-analysis that included patients with prior bariatric surgery and COVID-19 infection, which showed 78% and 72% risk reductions in mortality and hospitalization compared to patients with obesity without bariatric surgery [ 16 ]. Altogether, these findings indicate that bariatric surgery appears to protect a high-risk population from severe COVID-19 infection in the current pandemic context.…”

Section: Discussionmentioning

confidence: 52%

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Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center

et al. 2021

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Introduction Increased morbimortality in patients with COVID-19 infection who had undergone surgery has raised concerns about bariatric surgery safety during the current COVID-19 pandemic. Currently, there is scarce literature on safety outcomes after bariatric surgery during the COVID-19 pandemic. Objectives To determine the risk of symptomatic COVID-19 infection and associated complications during the first 30 days after bariatric surgery. Materials and Methods Prospective observational cohort study including all patients who consecutively underwent primary bariatric surgery between August and December 2020. Results A total of 189 patients were included. Median age and BMI were 36 (17–70) years and 38 (35–41) kg/m 2 , respectively. Forty percent of patients were women ( n = 76), 59.3% ( n = 112) underwent sleeve gastrectomy (SG), and 40.7% ( n = 77) underwent Roux-en-Y gastric bypass (RYGB). All surgeries were performed laparoscopically. The median length of postoperative stay was 2 (0–5) days. Postoperative COVID-19 infection was detected in two patients (1.1%): one patient was readmitted without the need of intermediate or ICU care, and the other was managed as an outpatient. Major complications occurred in three patients (1.6%); none of them was COVID-19 related. Two patients required an unplanned reoperation. No patient required intermediate or ICU care, no severe COVID-19 complications were observed, and no mortality was reported. Conclusion Bariatric surgery can be safely performed during the ongoing pandemic, albeit a low risk of COVID-19 symptomatic infection. Rigorous perioperative COVID-19 institutional protocols are required to perform bariatric surgery safely during the current pandemic. Graphical abstract

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Section: Discussionmentioning

confidence: 52%

“…The results are encouraging as they show a low risk of postoperative COVID-19 infection, and therefore a low risk of COVID-19 severe complications [ 13 – 15 ]. Moreover, preliminary evidence also suggests that bariatric surgery could protect against severe forms of COVID-19 infection in patients with prior bariatric surgery [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center

et al. 2021

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“…The link between the presence of obesity and poor COVID‐19‐related outcomes in children and adolescent patients is less clear, but the presence of obesity is still considered a significant risk for severe disease by the Centres for Disease Control and Prevention 30 . In adult patients, there are also data to suggest that a history of previous MBS is protective for patients in terms of outcomes from COVID‐19 compared to propensity‐matched controlled patients 31 . This further reinforces the need to continue to increase the provision of services to deliver MBS in order to reduce potential risks to patients living with obesity.…”

Section: Discussionmentioning

confidence: 89%

30‐Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID‐19 pandemic – The GENEVA study

Singhal

Super

Alqahtani³

et al. 2021

Pediatric Obesity

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Summary Background Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID‐19) pandemic. Methods This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in‐hospital and 30‐day COVID‐19 and surgery‐specific morbidity/mortality. Results One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre‐operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre‐operative testing for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self‐isolate pre‐operatively. Two patients developed symptomatic SARS‐CoV‐2 infection post‐operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions MBS in adolescents with obesity is safe during the COVID‐19 pandemic when performed within the context of local precautionary procedures (such as pre‐operative testing). The 30‐day morbidity rates were similar to those reported pre‐pandemic. These data will help facilitate the safe re‐introduction of MBS services for this group of patients.

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“…With limited therapies for COVID-19 infection, patients with substantial and sustained weight loss were likely physically and physiologically better equipped to cope with an infection that has the potential for multiorgan involvement. [22][23][24] The COVID-19 pandemic was a defining event that highlighted the major health consequences of obesity and the vulnerabilities of patients with excessive adipose tissue. The findings of this study emphasize the need to address obesity in an expeditious and comprehensive manner.…”

Section: Discussionmentioning

confidence: 99%

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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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

Cited by 22 publications

References 21 publications

Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center

Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center

30‐Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID‐19 pandemic – The GENEVA study

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

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