The First Modified Delphi Consensus Statement for Resuming Bariatric and Metabolic Surgery in the COVID-19 Times

Pouwels, Sjaak; Omar, Islam; Aggarwal, Sandeep; Aminian, Ali; Angrisani, Luigi; Balibrea, José María; Bhandari, Mohit; Biter, L. Ulas; Blackstone, Robin P.; Carbajo, Miguel Ángel Martín; Copăescu, Cătălin; Dargent, J.; Elfawal, Mohamed Hayssam; Fobi, Mathias; Greve, Jan-Willem M.; Hazebroek, Eric J.; Herrera, Miguel F.; Himpens, Jacques; Hussain, Farah A.; Kassir, Radwan; Kerrigan, David; Khaitan, Manish; Kow, Lilian; Kristinsson, Jon; Kurian, Marina; Lutfi, Rami; Moore, Rachel; Noe͏̈l, Patrick; Özmen, Mahir; Ponce, Jaime; Prager, Gerhard; Purkayastha, Sanjay; Rafols, Juan Pujol; Ramos, Almino Cardoso; Ribeiro, Rui; Sakran, Nasser; Salminen, Paulina; Shabbir, Asim; Shikora, Scott A.; Singhal, Rishi; Small, Peter; Taylor, Craig; Torres, Antonio; Vaz, Carlos; Yashkov, Yury I.; Mahawar, Kamal

doi:10.1007/s11695-020-04883-9

Cited by 21 publications

(32 citation statements)

References 8 publications

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“…Obesity is a known risk factor for Sars-Cov2 pulmonary complications, but in our series, body mass index (BMI) did not influence postoperative outcomes. This appears to be in contrast with a recent small case series reporting outcomes of bariatric surgery in patients with peri-operative diagnosis [ 13 ]. According to these principles, the Italian Society for Bariatric Surgery released recommendations for surgical treatment for high BMI patients during the pandemic [ 14 ].…”

Section: Discussionmentioning

confidence: 57%

Complications and mortality in a cohort of patients undergoing emergency and elective surgery with perioperative SARS-CoV-2 infection: an Italian multicenter study. Teachings of Phase 1 to be brought in Phase 2 pandemic

et al. 2021

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Since the beginning of the pandemic due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its related disease, coronavirus disease 2019 , several articles reported negative outcomes in surgery of infected patients. Aim of this study is to report results of patients with COVID-19-positive swab, in the perioperative period after surgery. Data of COVID-19-positive patients undergoing emergent or oncological surgery, were collected in a retrospective, multicenter study, which involved 20 Italian institutions. Collected parameters were age, sex, body mass index, COVID-19-related symptoms, patients' comorbidities, surgical procedure, personal protection equipment (PPE) used in operating rooms, rate of postoperative infection among healthcare staff and complications, within 30-postoperative days. 68 patients, who underwent surgery, resulted COVID-19-positive in the perioperative period. Symptomatic patients were 63 (92.5%). Fever was the main symptom in 36 (52.9%) patients, followed by dyspnoea (26.5%) and cough (13.2%). We recorded 22 (32%) intensive care unit admissions, 23 (33.8%) postoperative pulmonary complications and 15 (22%) acute respiratory distress syndromes. As regards the ten postoperative deaths (14.7%), 6 cases were related to surgical complications. One surgeon, one scrub nurse and two circulating nurses were infected after surgery due to the lack of specific PPE. We reported less surgery-related pulmonary complications and mortality in Sars-CoV-2-infected patients, than in literature. Emergent and oncological surgery should not be postponed, but it is mandatory to use full PPE, and to adopt preoperative screenings and strategies that mitigate the detrimental effect of pulmonary complications, mostly responsible for mortality. Keywords SARS-CoV-2 • COVID-19 • Pulmonary complications • Mortality Abbreviations SARS-COV-2 Severe acute respiratory syndrome coronavirus 2 COVID-19 Coronavirus disease 2019 HTN Hypertension CKD Chronic kidney disease COPD Chronic obstructive pulmonary disease PPE Personal protection equipment BMI Body mass index T2DM Type II diabetes mellitus ICU Intensive care unit ASA American Society of Anaesthesiologists ARDS Acute respiratory distress syndrome

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Section: Discussionmentioning

confidence: 57%

Complications and mortality in a cohort of patients undergoing emergency and elective surgery with perioperative SARS-CoV-2 infection: an Italian multicenter study. Teachings of Phase 1 to be brought in Phase 2 pandemic

et al. 2021

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“…The results from the present study have provided important and useful information on the trends in Implant Dentistry in the COVID‐19 era. Medical publications have recently used this methodology to generate consensus and provide recommendations for care in times of COVID‐19 (Alterio et al., 2020; Bhandari et al., 2020; Gelfand et al., 2020; Pouwels et al., 2020). The importance of these results is magnified by the fact that the study was carried out in the LA region, which presents its own cultural and economic characteristics.…”

Section: Discussionmentioning

confidence: 99%

Delphi Project on the trends in Implant Dentistry in the COVID‐19 era: Perspectives from Latin America

Alarcón

Sanz‐Sánchez

Shibli

et al. 2021

Clinical Oral Implants Res

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Aim To establish trends in Implant Dentistry in Latin America in the COVID‐19 pandemic. Material and methods A steering committee and an advisory group of experts in Implant Dentistry were selected among eighteen countries. An open‐ended questionnaire by Delphi methodology was validated including 64 questions, divided in 7 topics, concerning the various trends in dental implantology. The survey was conducted in two rounds, which provided the participants in the second round with the results of the first. The questionnaires were completed on August 2020, and the online meeting conference was held on September 2020. The final prediction was developed through consensus by a selected group of experts. Results A total of 197 experts from Latin America answered the first and second questionnaire. In the first round, the established threshold for consensus (65%) was achieved in 30 questions (46.87%). In the second round, performed on average 45 days later, this level was achieved in 47 questions (73.43%). Consensus was completely reached on the item “Diagnostic” (100%), the field with the lowest consensus was “Demand for treatment with dental implants” (37.5%). Conclusions The present study in Latin America has provided relevant and useful information on the predictions in the education and practice of Implant Dentistry in the COVID‐19 era. The consensus points toward a great confidence of clinicians in the biosecurity protocols used to minimize the risk of SARS‐CoV‐2 transmission. It is foreseen as an important change in education, with introduction of virtual reality and other simulation technologies in implant training.

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“…Months following the spread of the pandemic, several studies helped understand the complications associated with peri-operative COVID-19 infection, and hence better tailor the resumption of elective surgeries to the given circumstances. Given the risk of COVID-19 as a nosocomial infection, the "First Modified Delphi Consensus Statement for Resuming Bariatric and Metabolic Surgery in the COVID-19 Times" assured that any post-bariatric surgery patient who develops a persistent cough, fever, diarrhea, or vomiting should seek urgent medical care and consider being tested for COVID-19 [4].…”

Section: Covid-19mentioning

confidence: 99%

“…Postponing or canceling MBS led to a delayed resolution of obesity along with its comorbidities [4], including obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) which can increase the risk of developing pulmonary complications of COVID-19. Obesity itself was an independent risk factor for mortality in H1N1 patients [14].…”

Section: Metabolic Bariatric Surgery (Mbs) and Perioperative Covid-19mentioning

confidence: 99%

“…Thus, triaging patients is warranted. Authors agree that procedures should be performed in a hospital or a hospital wing free of COVID-19 patients [4]. Admitting an asymptomatic COVID-19 patient for an elective procedure impacts the overall surgical outcome and increases the risk of SARS-CoV-2 hospital transmission, whether to healthcare workers or other patients [18], which justifies routine PCR testing preoperatively.…”

Section: Resumption Of Mbsmentioning

confidence: 99%

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COVID-19 Infection Post-Laparoscopic Sleeve Gastrectomy: A Case Report and Review of Literature

et al. 2021

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Background: COVID-19 caused the suspension of elective surgeries in several hospitals around the world, in an attempt to help contain the spread of the virus. However, a safe resumption of such surgeries is warranted to reduce further burden on patients. It is important to understand when, how and where to resume elective surgeries, as published data suggested that peri-operative COVID-19 infection incurred an increased risk of morbidity and mortality to surgical patients. Case Report: A 25-year-old patient presented for fever 5 days post Laparoscopic Sleeve Gastrectomy. He was diagnosed with COVID-19 using a PCR test. The patient was managed at home with symptomatic therapy. No life-threatening complications were reported during or after his infection. Conclusion: Based on available data, our literature review regarding peri-operative COVID-19 complications, bariatric surgeons have to balance between the risk of undergoing an elective surgery like metabolic bariatric surgeries and the risk of postponing this procedure and thus delaying the resolution of obesity along with its comorbidities.

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The First Modified Delphi Consensus Statement for Resuming Bariatric and Metabolic Surgery in the COVID-19 Times

Cited by 21 publications

References 8 publications

Complications and mortality in a cohort of patients undergoing emergency and elective surgery with perioperative SARS-CoV-2 infection: an Italian multicenter study. Teachings of Phase 1 to be brought in Phase 2 pandemic

Complications and mortality in a cohort of patients undergoing emergency and elective surgery with perioperative SARS-CoV-2 infection: an Italian multicenter study. Teachings of Phase 1 to be brought in Phase 2 pandemic

Delphi Project on the trends in Implant Dentistry in the COVID‐19 era: Perspectives from Latin America

COVID-19 Infection Post-Laparoscopic Sleeve Gastrectomy: A Case Report and Review of Literature

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