Restarting Elective Bariatric and Metabolic Surgery Under a Security Protocol During the COVID-19 Pandemic—a Prospective Observational Cohort Study

Abstract

Background During the SARS-CoV-2 pandemic, in order to protect the patient and to save hospital beds, cancelation of elective surgeries has become a great challenge. Considering that obesity is a chronic disease and the possible effect imposed by quarantine on weight gain with worsening rates of obesity and metabolic comorbidities, the creation of a protocol for a safe return to bariatric surgery became essential. Objective The aim of this study was to identify the incidence of new-onset severe acute respiratory syndrome coronavirus (SARS-CoV-2) symptoms in patients who underwent bariatric procedures during the declining curve period. Setting Private practice Methods A prospective observational cohort study was conducted and included patients with indications for bariatric surgery during the decreasing curve period of the SARS-CoV-2 pandemic who underwent surgery under a hospital security protocol. Patients were asked to answer a questionnaire and had a swab PCR test for SARS-CoV-2 detection. The primary outcome measure was the presence of 14-day and 30-day postoperative symptoms associated with COVID-19. Mortality was also analyzed. Results Three hundred patients with negative RT-PCR were operated on from May to June 2020. Seventeen patients had their surgery postponed because of a positive RT-PCR test or close contact. None of the patients developed new-onset SARS-CoV-2 symptomatic infection after 30 days of observation. No deaths were reported. Eleven had complications not related to SARS-CoV-2. Conclusions Even though this population may have a poorer outcome when infected with SARS-CoV-2, this security protocol has shown that the procedure can be safely performed during the outbreak.

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

“…No mortality was reported, and no need for an intermediate or ICU bed was required. These results are in accordance with previous studies that report overall complications rates between 1 and 6.8%, major complications between 1 and 2.4%, and mortality rates between 0 and 0.5% [ 13 – 15 , 20 ]. Combined, these results are in line with pre-pandemic reported outcomes, indicating the safety of bariatric surgery with morbidity and mortality rates of 5% or less and 0.1%, respectively [ 30 ].…”

“…Perioperative COVID-19 infection has negatively impacted the safety of patients undergoing surgery, increasing complications and mortality rates [ 1 , 4 ]. Currently, only a few studies have reported data on the risk of perioperative COVID-19 infection and safety outcomes in patients undergoing bariatric surgery during the ongoing pandemic [ 13 – 15 , 20 ]. One study reported 87 consecutive patients who underwent SG during the opening phase between the first and second COVID-19 waves [ 14 ].…”

“…Postoperative symptomatic COVID-19 infection was reported in 6.3% of patients, with one patient having COVID-associated pneumonia during the first day after surgery with a negative preoperative PCR test. Another study involving 300 consecutive patients reported no symptomatic COVID-19 infection during the first 30 days after surgery [ 15 ]. Another study that included 178 patients reported 3.4% of patients who tested positive for COVID-19 without COVID-19-related readmission or mortality [ 20 ].…”

“…Over the last year, few studies have evaluated the safety of bariatric surgery during the opening phases between COVID-19 pandemic waves. 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 ].…”

Incidence of Symptomatic COVID-19 in Unvaccinated Patients Within One Month After Elective Total Joint Arthroplasty: A Multicenter Study

“…Previous studies have investigated the safety of other elective surgeries, such as bariatric surgery, during the COVID-19 pandemic ( 22 , 23 ). This international cohort study followed 7704 patients undergoing bariatric surgery for a month and reported that 43 patients (0.56%) developed symptomatic COVID-19 ( 22 ).…”