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

Abstract

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.

Impact of prior bariatric surgery on risk and severity of COVID-19 infection: A meta-analysis of observational studies

“…Seven studies enrolled hospitalized or non-hospitalized patients with COVID-19 infection [21] , [22] , [29] , [30] , [31] , [32] , [33] , while four studies investigated the infection rate of COVID-19 in the outpatient setting during the pandemic [20] , [23] , [34] , [35] . To reduce potential bias, five studies were conducted with the matched-cohort design in which patients in the BS group were matched with those who did not have surgical intervention for their obesity (control group) [20] , [21] , [22] , [29] , [31] . The other six studies included patients with obesity as the control group without matching their baseline characteristics (e.g., age, comorbidities) [23] , [30] , [32] , [33] , [34] , [35] .…”

“…The other six studies included patients with obesity as the control group without matching their baseline characteristics (e.g., age, comorbidities) [23] , [30] , [32] , [33] , [34] , [35] . For the seven studies that provided BMI in both groups, the range of BMI was 31-41 and 39-45 kg/m 2 in the BS and control groups, respectively [20] , [21] , [23] , [29] , [31] , [34] , [35] .…”

“…Analysis of the six studies with available information about the interval between previous BS and patient recruitment revealed a wide variation ranging from 3 months to 8.5 years [20] , [21] , [23] , [29] , [30] , [35] . The interval was more than one year in five studies [20] , [21] , [29] , [30] , [35] , while one enrolled patients undergoing BS 3 months ago as the study group and those with obesity waiting for surgical intervention as the controls [23] . Although one study reported that participants who received BS at least two weeks before the diagnosis of COVID-19 were eligible for inclusion, the actual interval was not provided [22] .…”

“…Nine studies enrolled participants with age more than 18 years, while the other two recruited individuals with age more than 15 [30] and 16 [22] years. The eleven studies were conducted in five countries, including USA (six studies) [20] , [22] , [29] , [31] , [32] , [33] , France (two studies) [21] , [30] , Italy (one study) [34] , Iran (one study) [35] , and Brazil (one study) [23] . Based on NOS, 90.9% (10/11) of the comparative cohort studies exhibited an overall low risk of bias (i.e., total score ≥ 7) ( Supplemental Table 3 ).…”

“…Nevertheless, despite the relatively large sample size, the weight of pooled evidence from that meta-analysis remains limited due to the small number of studies [19] . In view of the importance of this issue, there were several recent observational studies focusing on the association between prior BS and prognostic outcomes in patients with COVID-19 [20] , [21] , [22] , [23] . To provide robust evidence for clinical practice, the current meta-analysis aimed at systematically addressing this issue by incorporating the updated data to investigate the correlation of prior BS with the risk of mortality as well as its relationship with other prognostic outcomes including the need for advanced hospital care and the risks of complications.…”