30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries

Abstract

Background There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. Methods We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. Results Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. Conclusions BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.

The comparison of Post-Operative Complications pre Covid era versus during Covid-Era based on Clavien-Dindo-classification: A Systematic Review and Meta-Analysis

“…Half of centers provided FFP3/N95 masks in the operation room and staff-screening was performed in third of hospitals. They found same complication rate during the pandemic and concluded it is safe to continue surgery care using preventive protocols (38).…”

Is COVID-19 Severity Impacted by Bariatric Surgery in the Early Postoperative Period?

“…The data obtained in the GENEVA study were further complemented by a multinational cohort comprising 7704 patients analyzed between May and October 2020 [ 16 ]. Of the total number of patients, 43 (0.56%) had symptomatic COVID-19 in the first 30 days after surgery.…”

“…Most of these patients had surgical complications Clavien-Dindo I (67.4%) or II (25.6%), which may be due to the longer postoperative hospital stay. The study reported only one death related to COVID-19 [ 16 ].…”

Safe Surgery During the COVID-19 Pandemic

“…The 'Global 30-day outcomes after bariatric surgery during the COVID-19 pandemic' (GENEVA) showed that bariatric and metabolic surgery could be performed safely during the pandemic [39]. The complete dataset from this study has been reported recently for adults and adolescents [77,78]. In this study, 499 surgeons from 185 centres in 42 countries provided complete data on 7704 patients.…”