Are long waiting lists for bariatric surgery detrimental to patients? A single-centre experience

Background: We aimed to evaluate the impact of surgical delays due to the COVID-19 pandemic on a cohort of bariatric surgery waiting list patients at a single high-volume, accredited bariatric centre in Canada. Methods: We identified all patients on the waiting list who had consented to a primary bariatric operation before June 2021. A review of medical records and a structured telephone interview with each patient was conducted. Changes in weight, body mass index (BMI) and use of antiobesity medications were analyzed. Questions regarding patient experience on the waiting list were also analyzed. Results: Of 123 patients identified on the bariatric surgery waiting list, 97 (78.9%) participated in the survey and were enrolled in this study. Most patients were female (74.2%), with a mean age of 45.2 ± 10.6 years. The length of time on the waiting list was 8-33 months (mean 13.3 ± 4.8 months). The proportion of patients on antiobesity medications increased from 59.8% to 72.2%, although this was not statistically significant (p > 0.05). There was a small but statistically significant decrease in weight (140.0 ± 35.6 kg v. 135.5 ± 35.5 kg,p < 0.0001) and BMI (49.3 ± 9.9 kg/m2 v. 47.7 ± 10.2 kg/m2, p < 0.0001). However, there was no significant change in weight and BMI in the subgroup of patients who were not on antiobesity medications. In terms of patient experience, 39.2% of patients felt that they were negatively impacted by the length of time on the waiting list, and 16.5% were willing to travel out of province for their bariatric surgery. Conclusion: Patients on the bariatric surgery waiting list remained weight stable despite delays secondary to the COVID-19 pandemic. However, extended waiting times for bariatric surgery have had a negative impact on patient satisfaction.

Impact of the COVID-19 pandemic on bariatric surgery in North America: a retrospective analysis of 834 647 patients

Background: COVID-19 has transformed surgical care, yet little is known regarding implications for bariatric surgery. We sought to characterize the impact of COVID-19 on bariatric surgery delivery and outcomes. Methods: The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) collects data from 885 centres in North America. The MBSAQIP database was evaluated with 2 cohorts described: the COVID-19 and the pre-COVID-19, receiving surgery in 2020 and 2015-2019, respectively. Yearly operative trends were characterized, and bivariate analysis compared demographics and postoperative outcomes. Multivariable modelling evaluated 3-day readmission, reintervention, reoperation, and factors associated with undergoing Roux-en-Y gastric bypass (RYGB). Results: We evaluated 834 647 patients, with 155 830 undergoing bariatric surgery during the 2020 pandemic year. A 12.1% reduction in total cases (177 208 in 2019 v. 155 830 in 2020, p < 0.001) and 13.8% reduction in cases per centre occurred (204.2 cases/centre in 2019 v. 176.1 cases/centre in 2020, p < 0.001). Patients receiving bariatric surgery during the pandemic were younger and had fewer comorbidities. Use of sleeve gastrectomy increased (74.5% v. 72.5%, p < 0.001), and surgery during COVID-19 was associated with reduced RYGB procedural selection (odds ratio 0.83, 95% confidence interval 0.82-0.84, p < 0.001). Length of stay decreased significantly (1.4 ± 1.4 d v. 1.6 ± 1.4 d, p < 0.001), yet postoperative outcomes were similar. After adjusting for comorbidities, patients during COVID-19 had decreased 30-day odds of readmission and reintervention, with a small increased odds of reoperation. Conclusion: The COVID-19 pandemic dramatically changed the landscape of bariatric surgery delivery. Further studies evaluating the long-term effects of these changes are warranted.

Post-Operative but Not Pre-Operative COVID-19 Predicts Serious Complications and Mortality Following Elective Bariatric Surgery.

PURPOSE: We sought to characterize the prevalence and subsequent impact of pre- and post-operative COVID-19 diagnosis on bariatric surgery outcomes. COVID-19 has transformed surgical delivery, yet little is known regarding its implications for bariatric surgery. MATERIALS AND METHODS: The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) database was evaluated with three cohorts described: those diagnosed with COVID-19 pre-operatively (PRE), post-operatively (POST), and those without a peri-operative COVID-19 (NO) diagnosis. Pre-operative COVID-19 was defined as COVID-19 within 14 days prior to the primary procedure while post-operative COVID-19 infection was defined as COVID-19 within 30 days after the primary procedure. RESULTS: A total of 176,738 patients were identified, of which 174,122 (98.5%) had no perioperative COVID-19, 1364 (0.8%) had pre-operative COVID-19, and 1252 (0.7%) had post-operative COVID-19. Patients who were diagnosed with COVID-19 post-operatively were younger than other groups (43.0 ± 11.6 years NO vs 43.1 ± 11.6 years PRE vs 41.5 ± 10.7 years POST; p < 0.001). Pre-operative COVID-19 was not associated with serious complications or mortality after adjusting for comorbidities. Post-operative COVID-19, however, was among the greatest independent predictors of serious complications (OR 3.5; 95% CI 2.8-4.2; p < 0.0001) and mortality (OR 5.1; 95% CI 1.8-14.1; p = 0.002). CONCLUSIONS: Pre-operative COVID-19 within 14 days of surgery was not significantly associated with either serious complications or mortality. This work provides evidence that a more liberal strategy which employs early surgery after COVID-19 infection is safe as we aim to reduce the current bariatric surgery case backlog.

Characterization of Pre- and Postpandemic 30-Day Follow-Up After Elective Bariatric Surgery: a Retrospective MBSAQIP Analysis of 834,646 Patients.

BACKGROUND: Effects of the COVID-19 pandemic on rates of early postoperative follow-up after bariatric surgery are poorly understood. Our study characterizes 30-day follow-up after bariatric surgery prior to COVID-19 (years 2015-2019) and during the pandemic of COVID-19 (year 2020) and evaluates general predictive factors of short-term follow-up. METHODS: Data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2020. Cohorts were divided into pre-pandemic and pandemic years and patients with and without 30-day follow-up. Multivariable logistic regression analysis was used to identify general factors independently predictive of 30-day follow-up. The primary aim was to evaluate the impact of the COVID-19 pandemic on short-term 30-day follow-up adherence. A secondary outcome was to characterize general short-term postoperative 30-day follow-up associated with elective bariatric surgery and identify independent predictors of 30-day follow-up among bariatric surgery patients using multivariable logistic regression analysis. RESULTS: A total of 834,646 patients were identified. Follow-up rates significantly increased in the COVID era in 2020 (p < 0.0001). Patients who achieved 30-day follow-up were older and had an increased burden of medical comorbidities, including non-insulin and insulin-dependent diabetes mellitus, hypertension, dyslipidemia, as well as increased BMI compared to patients lacking follow-up. The cohort with successful 30-day follow-up was more likely to receive gastric bypass and had increased rates of metabolic comorbidities. After adjusting for comorbidities, the greatest independent predictors of follow-up were the 2020 COVID-19 era year, Asian race, black race, and gastroesophageal reflux disease. CONCLUSIONS: After adjusting for comorbidities, the 2020 COVID-19 era year was one of the greatest predictors of follow-up after bariatric surgery. Postoperative follow-up rates after elective bariatric surgery are excellent at > 95% and increased during the 2020 COVID-19 era year. Several independent predictors of follow-up were identified which may help in development of strategies aimed to mitigate lack of postoperative follow-up.

Effect of the COVID-19 pandemic on bariatric surgery in North America: a retrospective analysis of 834,647 patients.

BACKGROUND: COVID-19 has transformed surgical care, yet little is known regarding implications for bariatric surgery. OBJECTIVE: We sought to characterize the effect of COVID-19 on bariatric surgery delivery and outcomes. SETTING: The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) collects data from 885 centers in North America. METHODS: The MBSAQIP database was evaluated with 2 cohorts described: the COVID-19 and the pre-COVID-19, with patients receiving surgery in 2020 and 2015-2019, respectively. Yearly operative trends were characterized, and bivariate analysis compared demographics and postoperative outcomes. Multivariable modeling evaluated 30-day readmission, reintervention, and reoperation rates and factors associated with undergoing Roux-en-Y gastric bypass. RESULTS: We evaluated 834,647 patients, with 155,830 undergoing bariatric surgery during the 2020 pandemic year. A 12.1% reduction in total cases (177,208 in 2019 versus 155,830 in 2020; P < .001) and 13.8% reduction in cases per center occurred (204.2 cases per center in 2019 versus 176.1 cases per center in 2020; P < .001). Patients receiving bariatric surgery during the pandemic were younger and had fewer co-morbidities. Use of sleeve gastrectomy increased (74.5% versus 72.5%; P < .001), and surgery during COVID-19 was associated with reduced Roux-en-Y gastric bypass procedure selection (odds ratio = .83; 95% CI: .82-.84; P < .001). Length of stay decreased significantly (1.4 ± 1.4 days versus 1.6 ± 1.4 days; P < .001), yet postoperative outcomes were similar. After adjusting for co-morbidities, patients during COVID-19 had decreased 30-day odds of readmission and reintervention and a small increase in odds of reoperation. CONCLUSION: The COVID-19 pandemic dramatically changed bariatric surgery delivery. Further studies evaluating the long-term effects of these changes are warranted.