Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery

Abstract

Background: The SARS-CoV2 virus pandemic pandemic has been characterized for its rapid global dispersion. Obesity is an independent risk factor for the most severe cases of COVID-19. The impact in Argentina differs from others since it was able to anticipate public health interventions in order to atten the contagion curve. Early quarantine achieved better control of the pandemic and, following the recommendations of scienti c societies in countries with higher affectation, elective bariatric surgeries (BS) and in-person consults were suspended. Objective: Bariatric surgeons were surveyed to assess the impact of the pandemic and the measures undertaken on the practice of BS in Argentina. Method: Between April 17 and 21, 2020, an online survey in Google forms was disseminated to bariatric surgeons residing in Argentina. It consists of 40 speci c and non-speci c questions regarding BS practice and COVID pandemic. Consent to participate was obtained from surgeons by completing the survey. Results: 83 surgeons averaging 47.17 years of age responded the survey. Together they performed 10515 BS in 2019. More than 65% stated that more than 50% of their income derives from this activity, and more than 40% depend on more than 75% of it. The average hospital stay was 1.6 days and 85% reported using Intensive Care Unit (ICU) in less than 1% of their patients. According to the scores of hospital affectation issued by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), 54% reported being in Phase I and 34% had not yet been affected by the pandemic. All, except one, suspended the elective BS 7.7 days on average before the appearance of the rst local case. 95.7% offer virtual consults, but 48% obtain no retribution for them. 26% would consider performing BS without a previous endoscopic evaluation. 90% of the surgeons surveyed (75) continue performing other types of surgeries via laparoscopy. In case of operating a patient without suspected SARS-CoV-2 virus infection, 80% would use N95 masks and 56.6% would use face protection shields; two thirds would use smoke lters for the pneumoperitoneum and only 10.8% would continue with the usual protection measures. To restart the elective activity, 56.6% proposed that the hospital should be in phase 0 or I, that the patient should meet certain characteristics for their selection and that the scienti c society must recommend the way to restart of the activity. Patient selection criteria with greater consensus were testing to rule out asymptomatic COVID-positive patients, epidemiology, absence of chronic lung disease, age under 60, and immunological integrity. 19.2% regard sleeve gastrectomy as the ideal BS during the pandemic, and 88% of the surgeons would not change their chosen BS technique based on infection risk. Conclusion: Elective BS is currently suspended in Argentina, although epidemiologically the conditions in the country are not unfavorable. Economic impact for those involved is signi cant. Short-term vision is pessimistic, but recommendations originati...

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