ABSTRACT
BACKGROUND: The global COVID-19 pandemic has resulted in the widespread suspension of bariatric surgical programs. Although this rapid adaption was initially necessary, the implications of delaying the most effective treatment for weight loss in a population at risk from this crisis are not well known. Moreover, as the health care trusts plan the reintroduction of elective services, it is vital to also consider the patient's perspectives, to adequately weigh up the benefits and risks of this recommencement in the current climate. OBJECTIVES: We aimed to investigate the impacts that postponing bariatric surgery has had on patients, and their priorities when restarting elective surgery. METHODS: An online survey of patients awaiting surgery was undertaken, examining the physical and psychological impacts of pandemic isolation policies and postponing surgery, and exploring patient preferences regarding surgery during the pandemic. RESULTS: Of 71 patients, 67.6% gained a median of 4 kg (interquartile range: 2.6-6.4), and 74.6% had adverse psychological effects; 93.0% were keen to proceed with surgery. Thematic analysis of qualitative data revealed delays have worsened physical symptoms, increased anxiety, and delayed secondary life-altering treatments. CONCLUSION: From the patient's perspective, postponing surgery has been deleterious and efforts to safely reintroduce bariatric programs should be promoted.
ABSTRACT
INTRODUCTION: The COVID-19 pandemic has resulted in unparalleled changes to patient care, including the suspension of cancer surgery. Concerns regarding COVID-19-related risks to patients and healthcare workers with the re-introduction of major complex minimally invasive and open surgery have been raised. This study examines the COVID-19 related risks to patients and healthcare workers following the re-introduction of major oesophago-gastric (EG) surgery. PATIENTS AND METHODS: This was an international, multi-centre, observational study of consecutive patients treated by open and minimally invasive oesophagectomy and gastrectomy for malignant or benign disease. Patients were recruited from nine European centres serving regions with a high population incidence of COVID-19 between 1 May and 1 July 2020. The primary endpoint was 30-day COVID-19-related mortality. All staff involved in the operative care of patients were invited to complete a health-related survey to assess the incidence of COVID-19 in this group. RESULTS: In total, 158 patients were included in the study (71 oesophagectomy, 82 gastrectomy). Overall, 87 patients (57%) underwent MIS (59 oesophagectomy, 28 gastrectomy). A total of 403 staff were eligible for inclusion, of whom 313 (78%) completed the health survey. Approaches to mitigate against the risks of COVID-19 for patients and staff varied amongst centres. No patients developed COVID-19 in the post-operative period. Two healthcare workers developed self-limiting COVID-19. CONCLUSIONS: Precautions to minimise the risk of COVID-19 infection have enabled the safe re-introduction of minimally invasive and open EG surgery for both patients and staff. Further studies are necessary to determine the minimum requirements for mitigations against COVID-19.