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. 2021 Oct;31(10):4272-4288.
doi: 10.1007/s11695-021-05493-9. Epub 2021 Jul 30.

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  1 , Christian Ludwig  2 , Gavin Rudge  3 , Georgios V Gkoutos  4   5   6   7 , Abd Tahrani  2   8   9 , Kamal Mahawar  10 ; GENEVA Collaborators; Michał Pędziwiatr, Piotr Major, Piotr Zarzycki, Athanasios Pantelis, Dimitris P Lapatsanis, Georgios Stravodimos, Chris Matthys, Marc Focquet, Wouter Vleeschouwers, Antonio G Spaventa, Carlos Zerrweck, Antonio Vitiello, Giovanna Berardi, Mario Musella, Alberto Sanchez-Meza, Felipe J Cantu Jr, Fernando Mora, Marco A Cantu, Abhishek Katakwar, D Nageshwar Reddy, Haitham Elmaleh, Mohammad 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 Senol, Emilio Manno, Michele Giuseppe Iovino, Ahmed Osman, Mohamed Qassem, Sebastián Arana-Garza, Heitor P Povoas, Marcos Leão Vilas-Boas, David 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, Andre Lazaro, Jose Campos, Joaquín Bernardo, Jesús 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 Pinango, Patricia Martinez Ortega, Rafael Moncada, Victor Valenti, Ivan Vlahović, Zdenko Boras, Arnaud Liagre, Francesco Martini, Gildas Juglard, Manish Motwani, Sukhvinder Singh Saggu, Hazem Al Moman, Luis Adolfo Aceves López, María Angelina Contreras Cortez, Rodrigo Aceves Zavala, Christine D'Haese, Ivo Kempeneers, Jacques Himpens, Andrea Lazzati, Luca Paolino, Sarah Bathaei, Abdulkadir Bedirli, Aydın Yavuz, Çağrı Büyükkasap, Safa Özaydın, Andrzej Kwiatkowski, Katarzyna Bartosiak, Maciej Walędziak, Antonella Santonicola, Luigi Angrisani, Paola Iovino, Rossella Palma, Angelo Iossa, Cristian Eugeniu Boru, Francesco De Angelis, Gianfranco Silecchia, Abdulzahra Hussain, Srivinasan Balchandra, Izaskun Balciscueta Coltell, Javier Lorenzo Pérez, Ashok Bohra, Altaf K Awan, Brijesh Madhok, Paul C Leeder, Sherif Awad, Waleed Al-Khyatt, Ashraf Shoma, Hosam Elghadban, Sameh Ghareeb, Bryan Mathews, Marina Kurian, Andreas Larentzakis, Gavriella Zoi Vrakopoulou, Konstantinos Albanopoulos, Ahemt Bozdag, Azmi Lale, Cuneyt Kirkil, Mursid Dincer, Ahmad Bashir, Ashraf Haddad, Leen Abu Hijleh, Bruno Zilberstein, Danilo Dallago de Marchi, Willy Petrini Souza, Carl Magnus Brodén, Hjörtur Gislason, Kamran Shah, Antonio Ambrosi, Giovanna Pavone, Nicola Tartaglia, S Lakshmi Kumari Kona, K Kalyan, Cesar Ernesto Guevara Perez, Miguel Alberto Forero Botero, Adrian Covic, Daniel Timofte, Madalina Maxim, Dashti Faraj, Larissa Tseng, Ronald Liem, Gürdal Ören, Evren Dilektasli, Ilker Yalcin, Hudhaifa AlMukhtar, Mohammed Al Hadad, Rasmi Mohan, Naresh Arora, Digvijaysingh Bedi, Claire Rives-Lange, Jean-Marc Chevallier, Tigran Poghosyan, Hugues Sebbag, Lamia Zinaï, Saadi Khaldi, Charles Mauchien, Davide Mazza, Georgiana Dinescu, Bernardo Rea, Fernando Pérez-Galaz, Luis Zavala, Anais Besa, Anna Curell, Jose M Balibrea, Carlos Vaz, Luis Galindo, Nelson Silva, José Luis Estrada Caballero, Sergio Ortiz Sebastian, João Caetano Dallegrave Marchesini, Ricardo Arcanjo da Fonseca Pereira, Wagner Herbert Sobottka, Felipe Eduardo Fiolo, Matias Turchi, Antonio Claudio Jamel Coelho, Andre Luis Zacaron, André Barbosa, Reynaldo Quinino, Gabriel Menaldi, Nicolás Paleari, Pedro Martinez-Duartez, Gabriel Martínez de Aragon Ramírez de Esparza, Valentin Sierra Esteban, Antonio Torres, Jose Luis Garcia-Galocha, Miguel Josa, Jose Manuel Pacheco-Garcia, Maria Angeles Mayo-Ossorio, Pradeep Chowbey, Vandana Soni, Hercio Azevedo de Vasconcelos Cunha, Michel Victor Castilho, Rafael Meneguzzi Alves Ferreira, Thiago Alvim Barreiro, Alexandros Charalabopoulos, Elias Sdralis, Spyridon Davakis, Benoit Bomans, Giovanni Dapri, Koenraad Van Belle, Mazen Takieddine, Pol Vaneukem, Esma Seda Akalın Karaca, Fatih Can Karaca, Aziz Sumer, Caghan Peksen, Osman Anil Savas, Elias Chousleb, Fahad Elmokayed, Islam Fakhereldin, Hany Mohamed Aboshanab, Talal Swelium, Ahmad Gudal, Lamees Gamloo, Ayushka Ugale, Surendra Ugale, Clara Boeker, Christian Reetz, Ibrahim Ali Hakami, Julian Mall, Andreas Alexandrou, Efstratia Baili, Zsolt Bodnar, Almantas Maleckas, Rita Gudaityte, Cem Emir Guldogan, Emre Gundogdu, Mehmet Mahir Ozmen, Deepti Thakkar, Nandakishore Dukkipati, Poonam Shashank Shah, Shashank Subhashchandra Shah, Simran Shashank Shah, Md Tanveer Adil, Periyathambi Jambulingam, Ravikrishna Mamidanna, Douglas Whitelaw, Md Tanveer Adil, Vigyan Jain, Deepa Kizhakke Veetil, Randeep Wadhawan, Antonio Torres, Max Torres, Tabata Tinoco, Wouter Leclercq, Marleen Romeijn, Kelly van de Pas, Ali K Alkhazraji, Safwan A Taha, Murat Ustun, Taner Yigit, Aatif Inam, Muhammad Burhanulhaq, Abdolreza Pazouki, Foolad Eghbali, Mohammad Kermansaravi, Amir Hosein Davarpanah Jazi, Mohsen Mahmoudieh, Neda Mogharehabed, Gregory Tsiotos, Konstantinos Stamou, Francisco J Barrera Rodriguez, Marco A Rojas Navarro, Omar MOhamed Torres, Sergio Lopez Martinez, Elda Rocio Maltos Tamez, Gustavo A Millan Cornejo, Jose Eduardo Garcia Flores, Diya Aldeen Mohammed, Mohamad Hayssam Elfawal, Asim Shabbir, Kim Guowei, Jimmy By So, Elif Tuğçe Kaplan, Mehmet Kaplan, Tuğba Kaplan, DangTuan Pham, Gurteshwar Rana, Mojdeh Kappus, Riddish Gadani, Manish Kahitan, Koshish Pokharel, Alan Osborne, Dimitri Pournaras, James Hewes, Errichetta Napolitano, Sonja Chiappetta, Vincenzo Bottino, Evelyn Dorado, Axel Schoettler, Daniel Gaertner, Katharina Fedtke, Francisco Aguilar-Espinosa, Saul Aceves-Lozano, Alessandro Balani, Carlo Nagliati, Damiano Pennisi, Andrea Rizzi, Francesco Frattini, Diego Foschi, Laura Benuzzi, Chirag Parikh, Harshil Shah, Enrico Pinotti, Mauro Montuori, Vincenzo Borrelli, Jerome Dargent, Catalin A Copaescu, Ionut Hutopila, Bogdan Smeu, Bart Witteman, Eric Hazebroek, Laura Deden, Laura Heusschen, Sietske Okkema, Theo Aufenacker, Willem den Hengst, Wouter Vening, Yonta van der Burgh, Ahmad Ghazal, Hamza Ibrahim, Mourad Niazi, Bilal Alkhaffaf, Mohammad Altarawni, Giovanni Carlo Cesana, Marco Anselmino, Matteo Uccelli, Stefano Olmi, Christine Stier, Tahsin Akmanlar, Thomas Sonnenberg, Uwe Schieferbein, Alejandro Marcolini, Diego Awruch, Marco Vicentin, Eduardo Lemos de Souza Bastos, Samuel Azenha Gregorio, Anmol Ahuja, Tarun Mittal, Roel Bolckmans, Tom Wiggins, Clément Baratte, Judith Aron Wisnewsky, Laurent Genser, Lynn Chong, Lillian Taylor, Salena Ward, Lynn Chong, Lillian Taylor, Michael W Hi, Helen Heneghan, Naomi Fearon, Andreas Plamper, Karl Rheinwalt, Helen Heneghan, Justin Geoghegan, Kin Cheung Ng, Naomi Fearon, Krzysztof Kaseja, Maciej Kotowski, Tarig A Samarkandy, Adolfo Leyva-Alvizo, Lourdes Corzo-Culebro, Cunchuan Wang, Wah Yang, Zhiyong Dong, Manel Riera, Rajesh Jain, Hosam Hamed, Mohammed Said, Katia Zarzar, Manuel Garcia, Ahmet Gökhan Türkçapar, Ozan Şen, Edoardo Baldini, Luigi Conti, Cacio Wietzycoski, Eduardo Lopes, Tadeja Pintar, Jure Salobir, Cengiz Aydin, Semra Demirli Atici, Anıl Ergin, Huseyin Ciyiltepe, Mehmet Abdussamet Bozkurt, Mehmet Celal Kizilkaya, Nezihe Berrin Dodur Onalan, Mariana Nabila Binti Ahmad Zuber, Wei Jin Wong, Amador Garcia, Laura Vidal, Marc Beisani, Jorge Pasquier, Ramon Vilallonga, Sharad Sharma, Chetan Parmar, Lyndcie Lee, Pratik Sufi, Hüseyin Sinan, Mehmet Saydam
Affiliations

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 et al. Obes Surg. 2021 Oct.

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.

Keywords: Bariatric surgery; COVID-19; Obesity surgery; Pandemic; Revisional surgery; SARS-CoV-2.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The temporal relationship between the country incidence of COVID-19 and the reported post-BS symptomatic COVID-19 cases. Daily cumulative infection data were downloaded from John’s Hopkins University git repository19 and differentiated to obtain daily numbers of new infection cases. In order to analytically define peak maxima of new infections, data curves for each country were fed through a low-pass Butterworth filter. Maxima were automatically detected if local maxima had a width of at least 7 days and reached at least 15% of the maximum number of infections of the country. Day of surgery is indicated for each SARS-CoV2 positive patient with a dot. The darker shaded area after each dot indicates the 30-day follow-up period. The study period started at 01/05/2020 and ended at 30/11/2020. The top three panels were used to show this data due to the differences in the scale of incidence of SARS-CoV-2 infection in respective countries. The bottom panel illustrates the tertiles and infections/ day in Argentina. Patient A had date of surgery and 30-day follow-up within the lower and middle tertile. Patient B had the 30-day follow-up in the top tertile and Patient C had date of surgery and 30-day follow-up in the top tertile of the number of cases
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