30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries
Rishi Singhal, Christian Ludwig, Gavin Rudge, Georgios V. Gkoutos, Abd A. Tahrani, Kamal Mahawar, on behalf of the GENEVA Collaborators, Michał Pędziwiatr, Piotr Major, Piotr Zarzycki, Athanasios Pantelis, Dimitris P. Lapatsanis, Georgios Stravodimos, Chris Matthys, Marc Focquet, Wouter Vleeschouwers, Antonio Spaventa, Carlos Zerrweck, Antonio Vitiello, Giovanna Berardi, Mario Musella, Alberto Sanchez-Meza, Felipe J. Cantu, Fernando Mora, Marco Cantù, Abhishek Katakwar, D. Nageshwar Reddy, H Elmaleh, Mohammad Mahmudul Hassan, Abdelrahman Elghandour, Mohey Elbanna, Ahmed Osman, Athar Khan, Laurent Layani, Nalini Kiran, Andrey Velikorechin, Maria Solovyeva, Hamid Melali, Shahab Shahabi, Ashish Agrawal, Apoorv Shrivastava, Ankur Sharma, Bhavya Narwaria, Mahendra Narwaria, Asnat Raziel, Nasser Sakran, Sergio Susmallian, Levent Karagöz, Murat Akbaba, Salih Zeki Pişkin, Ahmet Ziya Balta, Zafer Şenol, Emilio Manno, Michele Iovino, Ahmed Osman, Mohamed Gamal Qassem, Sebastián Arana-Garza, Heitor P. Póvoas, Marcos Leão Vilas-Bôas, David N Naumann, Jonathan Super, Alan Li, Basil J. Ammori, Hany Balamoun, Mohammed Salman, Amrit Manik Nasta, Ramen Goel, Hugo Sánchez-Aguilar, Miguel F. Herrera, Adel Abou‐Mrad, Lucie Cloix, Guilherme Silva Mazzini, Leonardo Kristem, André Lázaro, José Luis Campos, Joaquín Bernardo, Jesús Santos González, Carlos Trindade, Octávio Viveiros, Rui Ribeiro, David Goitein, David Hazzan, Lior Segev, Tamar Beck, Hernán Reyes, Jerónimo Monterrubio, Paulina García, Marine Benois, Radwan Kassir, Alessandro Contine, Moustafa Elshafei, Sueleyman Aktas, Sylvia Weiner, Till Heidsieck, Luis Level, Silvia Piñango, Patricia Ortega, Rafael Moncada, Víctor Valentí, Ivan Vlahović
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.