Association of prior metabolic and bariatric surgery with severity of coronavirus disease 2019 (COVID-19) in patients with obesity

Abstract

Background: Obesity is a risk factor for poor clinical outcomes in patients with coronavirus disease 2019 (COVID-19).

Objectives: To investigate the relationship between prior metabolic surgery and the severity of COVID-19 in patients with severe obesity.

Setting: Cleveland Clinic Health System in the United States.

Methods: Among 4365 patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 8, 2020 and July 22, 2020 in the Cleveland Clinic Health System, 33 patients were identified who had a prior history of metabolic surgery. The surgical patients were propensity matched 1:10 to nonsurgical patients to assemble a cohort of control patients (n = 330) with a body mass index (BMI) ≥ 40 kg/m² at the time of SARS-CoV-2 testing. The primary endpoint was the rate of hospital admission. The exploratory endpoints included admission to the intensive care unit (ICU), need for mechanical ventilation and dialysis during index hospitalization, and mortality. After propensity score matching, outcomes were compared in univariate and multivariate regression models.

Results: The average BMI of the surgical group was 49.1 ± 8.8 kg/m² before metabolic surgery and was down to 37.2 ± 7.1 at the time of SARS-CoV-2 testing, compared with the control group's BMI of 46.7 ± 6.4 kg/m². In the univariate analysis, 6 (18.2%) patients in the metabolic surgery group and 139 (42.1%) patients in the control group were admitted to the hospital (P = .013). In the multivariate analysis, a prior history of metabolic surgery was associated with a lower hospital admission rate compared with control patients with obesity (odds ratio, 0.31; 95% confidence interval, 0.11-0.88; P = .028). While none of the 4 exploratory outcomes occurred in the metabolic surgery group, 43 (13.0%) patients in the control group required ICU admission (P = .021), 22 (6.7%) required mechanical ventilation, 5 (1.5%) required dialysis, and 8 (2.4%) patients died.

Conclusion: Prior metabolic surgery with subsequent weight loss and improvement of metabolic abnormalities was associated with lower rates of hospital and ICU admission in patients with obesity who became infected with SARS-CoV-2. Confirmation of these findings will require larger studies.

Keywords: Bariatric surgery; COVID-19; Coronavirus; Diabetes; Metabolic surgery; Obesity; SARS-CoV-2; Weight loss.

Fig. 1

Primary analysis: univariate comparison of study outcomes for COVID-19 patients with history of metabolic surgery (n = 33) versus a matched control group with BMI ≥ 40 kg/m² (n = 330). Chi-square test P value of .013 for hospital admission and Fisher’s exact test P value of .021 for ICU admission. COVID-19 = coronavirus disease 2019; BMI = body mass index; ICU = intensive care unit.

Fig. 2

Sensitivity analysis: univariate comparison of study outcomes for COVID-19 patients with history of metabolic surgery (n = 33) versus a matched control group with BMI ≥ 35 kg/m² (n = 330). Chi-square test P value of .006 for hospital admission and Fisher’s exact test P value of .022 for ICU admission. COVID-19 = coronavirus disease 2019; BMI = body mass index; ICU = intensive care unit.