Bariatric surgery can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols, according to the findings from the Global 30-day outcomes of bariatric surgEry iN thE coVid-19 erA (GENEVA) study. The study, which recruited more than 7,700 patients from 42 countries, found that the risk of postoperative COVID-19 was greater in non-whites or if surgery was performed during a local peak. The paper, ‘30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries’, was published in Obesity Surgery.
The authors, writing on behalf of the GENEVA Collaborators (490 surgeons from 185 centres in 42 countries) undertook the research to examine that the associations between obesity and severe COVID-19, patients’ concerns regarding the availability and safety of bariatric during the pandemic, and the negative impact of the pandemic and lockdowns on the health and eating and physical activity behaviours during the COVID-19 pandemic.
The GENEVA study was designed to capture 30-day morbidity and mortality of bariatric surgery performed during the COVID-19 pandemic. The results of the first 2,001 patients were reported in The Lancet Diabetes Endocrinology (Singhal R, Tahrani AA, Ludwig C, et al. Global 30-day outcomes after bariatric surgery during the COVID-19 pandemic (GENEVA): an international cohort study. 2021;9(1):7–9). This paper reported that 30-day morbidity and mortality following surgery - with locally appropriate perioperative COVID-19 protocols in place - seemed to be similar to pre-pandemic levels.
However, as there have been there have been further peaks of COVID-19 globally, the researchers continued to collect data and expanded the study to include an additional 5703 patients (from 281 more surgeons from 58 more centres in seven countries). The primary outcome measure was all-cause and COVID-19-specific 30-day morbidity and mortality of surgery. All laparoscopic, open, robotic or hybrid surgical procedures were included, as well as emergency surgery related to previous bariatric surgery.
Outcomes
In total data on 7,704 was included in the latest analysis, of which 91.9% of patient had elective primary bariatric surgery with 449 (5.8%) and 171 (2.2%) patients underwent elective revisional surgery and emergency surgery following a previous bariatric surgery, respectively. The majority of patients were young white females (5,197; 73.4%); a quarter of the study population were non-whites (1,813; 25.59%). Most patients had a laparoscopic sleeve gastrectomy (LSG, 3988 (51.8%), followed by laparoscopic Roux-en-Y gastric bypass (LRYGB, 2091 (14.2%) and laparoscopic one anastomosis gastric bypass (LOAGB, 705 (9.2%) respectively. Three hundred (3.9%) patients underwent other procedures.
Four hundred seventy-nine (6.76%) patients undergoing primary surgery developed at least one complication. Complication rates were higher in patients undergoing elective revisional surgery (n=53/449, 11.8%) and those undergoing emergency surgery (n=35/171, 20.46%), compared to primary surgery, no deaths were reported in these groups.
The authors report that increasing age, male sex, being a current or former smoker (vs. non-smoker), having insulin-dependent type 2 diabetes (T2D; vs. patients who did not have diabetes), obstructive sleep apnoea (OSA) not on continuous positive airways pressure (CPAP) (vs. patients did not have OSA), hypertension, and hypercholesterolaemia were associated with increased complication levels – after logit regression analysis. Emergency procedures and revisional procedures were associated with higher odds of increased complications, as was primary LRYGB or other primary procedures as compared to primary LSG. The experience of the surgeon also appeared significant.
Of the 10 patients who died, four died due to leaks (3 following LOAGB and 1 following LSG), two died due to pulmonary embolism (PE), one died of COVID-19 pneumonia with PE, one died of mesenteric thrombosis, one died of bleeding, and one died of multi-organ failure.
The patient who was diagnosed with COVID pneumonia postoperatively had been advised to self-isolate for two weeks preoperatively and also had a negative RT-PCR preoperatively. Of the remaining nine patients, three (33.3%) had been advised preoperative self-isolation and six (66.6%) had preoperative testing for SARS-CoV-2.
A majority of patients (54%, n=4,068) of elective (primary and revisional) patients were not recommended any preoperative self-isolation and 19.8% (n=1,491) of the patients did not undergo any preoperative testing to rule out SARS-CoV-2 infection. One hundred thirty-six out of 185 centres indicated that they were treating COVID-19 patients in the same hospitals (6,086 patients; 79%), as opposed to 49 centres where the facility was not treating COVID-19 patients (1,618 patients; 21%). Testing of staff was performed in 67 centres (2,144 patients; 27.8%). Forty-three patients (0.56%) developed symptomatic COVID-19 postoperatively, 38 had undergone elective primary surgery, two had elective revisional surgery and three emergency surgery.
“Bariatric and metabolic surgery can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. Non-white ethnicity and having surgery during a local peak of COVID-19 for that country were associated with a greater risk of symptomatic COVID-19 postoperatively,” the aathors concluded. “There was no relationship between preoperative testing for COVID-19/ preoperative self-isolation and incidence of symptomatic postoperative COVID-19 perhaps suggesting that the measures to reduce the postoperative viral exposure are equally important.”
Further reading
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