Primary Care Physicians' Knowledge, Attitude and Practice towards Bariatric Operations in the Kingdom of Bahrain

Background: Obesity is an epidemic treatable disease. In Bahrain, the prevalence of obesity was 36.2%. Bariatric surgery should be considered for patients with BMI >= 40, or >= 30 with obesity-related comorbidities. Family physicians have a key role in identifying and counseling patients who may qualify for bariatric surgery. The most common reason for physicians' refusal of referral for bariatric surgeries is fear of complications followed by concern of ineffective weight loss following the surgery. Doctors are not comfortable providing post bariatric operation care. Aim(s): To study the PCPs' knowledge, attitude and practice towards bariatric surgeries in the kingdom of Bahrain. Method(s): this is a cross-sectional study of a convenient sample of physicians working in the Kingdom of Bahrain health centers, using an electronic and manual questionnaire to test the knowledge, attitude and practice towards bariatric surgery. Result(s): The sample included a total of 222 participants. 56.1% agreed that the BMI >= 40 without weight related comorbidities is an indication for bariatric surgery and 92.3% of them referred patients for bariatric surgery, with BMI (88.6%) as the most influential factor followed by presence of comorbidities (87.8%). On the other hand, lack of resources was the main cause for not referring patient for bariatric surgery (29.4%) followed by concerns with follow up (23.5%). 80.6% are comfortable to initiate conversations with their patients about bariatric surgery, while 36.1% feel comfortable explaining the procedural options to a patient. 83.8% agreed that additional medical education in bariatric surgical care would be useful. Conclusion(s): Primary care physicians showed well knowledge about the referral criteria to bariatric surgeries and that's reflected by the high referral rate (92.3%). But there is a gap in the knowledge mean score across different age groups and experience. Less than half of the physicians are not comfortable dealing with patients. Continuous medical education is essential to address the gap and to establish comprehensive obesity management guidelines for primary care physicians.Copyright © 2023, Bahrain Medical Bulletin. All rights reserved.

Successful Pregnancy in a Woman of Advanced Maternal Age at Sixteen Months Post-Roux-en-Y Gastric Bypass Revision.

Obesity, defined as body mass index (BMI) > 30 kg/m2, complicates maternal and neonatal outcomes. Bariatric surgery (BS) is an option for weight reduction in several populations, including reproductive-aged women. However, there is a lack of consensus regarding the ideal time interval between BS and pregnancy. We report the case of a 43-year-old Hispanic female who underwent an initial Roux-en-Y gastric bypass (RYGB) in 2011, followed by a revision eight years later in 2019. The revision entailed the reduction of the gastric pouch size and the excision of the remnant stomach. It occurred sixteen months before the conception of her second pregnancy. Despite advanced maternal age and nutritional challenges following BS, this patient delivered a healthy male neonate and maintained a net weight loss compared to her preoperative weight. Factors leading to this positive outcome included the patient's adherence to dietary recommendations following the procedure and using weight loss adjuncts (phentermine and topiramate) to promote post-procedure weight loss. Sixteen months between RYGB revision and conception can lead to positive pregnancy outcomes, even in women of advanced maternal age and multiple prior BS. Further studies are required to understand better the optimal interval to reduce maternal and neonatal complications following RYGB specifically and the use of medications as weight loss adjuncts.

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.

An unusual case of early small bowel obstruction after Roux-en-Y gastric bypass by the free end of a V-loc™ suture.

Weight recurrence and gastro-esophageal reflux disease are the most common causes for re-operation after sleeve gastrectomy (SG); Roux-en-Y gastric bypass is the recommended procedure to correct both problems. The V-loc™ (Covidien, Dublin, Ireland) enables faster suturing and less operative time compared to non-barbed sutures. We report an unusual case of early obstruction at the jejunojejunostomy by the tail of V-loc™ suture which grasped surrounding tissue causing adhesions and subsequent obstruction. When reviewing the literature for complications of V-loc™, we found three cases of bowel obstruction caused by the leftover free segment of V-loc™. So, V-loc™ thread can cause small bowel obstruction; therefore, we recommend not leaving an extra length at its free end and keep it to a minimum length possible.

Same-Day Discharge After Laparoscopic Roux-en-Y Gastric Bypass: a Cohort of 500 Consecutive Patients.

INTRODUCTION: There is an increasing demand on hospital capacity worldwide due to the COVID-19 pandemic and local staff shortages. Novel care pathways have to be developed in order to keep bariatric and metabolic surgery maintainable. Same-day discharge (SDD) after laparoscopic Roux-en-Y gastric bypass (RYGB) is proved to be feasible and could potentially solve this challenge. The aim of this study was to investigate whether SDD after RYGB is safe for a selected group of patients. METHODS: In this single-center cohort study, low-risk patients were selected for primary RYGB with intended same-day discharge with remote monitoring. All patients were operated according to ERAS protocol. There were strict criteria on approval upon same-day discharge. It was demanded that patients should contact the hospital in case of any signs of complications. Primary outcome was the rate of successful same-day discharge without readmission within 48 h. Secondary outcomes included short-term complications, emergency department visits, readmissions, and mortality. RESULTS: Five hundred patients underwent RYGB with intended SDD, of whom 465 (93.0%) were successfully discharged. Twenty-one patients (4.5%) were readmitted in the first 48 h postoperatively. None of these patients had a severe bleeding. This results in a success rate of 88.8% of SDD without readmission within 48 h. CONCLUSIONS: Same-day discharge after RYGB is safe, provided that patients are carefully selected and strict discharge criteria are used. It is an effective care pathway to reduce the burden on hospital capacity.

Effect of COVID 19 Lockdown on Weight Change in Post-Surgical Bariatric Patients

Katarina Bade Hartford CT CT1, Richard Seip Hartford CT1, Tara McLaughlin Vernon Rockville CT1, Darren Tishler Glastonbury CT1, Ilene Staff Hartford CT2, Connie Santana Glastonbury CT1, Aziz Benbrahim MERIDEN CT3, Meagan Moskowitz Meriden CT3, Pavlos Papasavas Hartford CT1 Hartford Hospital1 Hartford Hospital2 Mid State Medical Center3 Introduction: Safe and effective weight loss immediately following bariatric surgery occurs in concert with both social and medical support. Interruption of support networks may threaten weight loss. During the COVID19 pandemic, a Connecticut state-mandated “lockdown” from 3/15 to 5/18/2020 suspended in-person services and interrupted social support. We investigated the effect of exposure to 63 days of COVID lockdown within 12 months of index sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) on weight loss. Methods: This single center, retrospective chart review identified 1057 patients with 1 year follow-up data who underwent SG or RYGB from 1/9/2016 to 12/30/20. Controls (Group C) (SG n750, RYGB n130) completed surgery and follow up from 1/9/2016 to 3/15/20, before lockdown. Lockdown patients (Group L) (SG n159, RYGB n18) completed surgery before 3/15/20, and follow up after the lockdown (5/20/20 to 12/31/2020). Weight loss (WL) was compared between C and L, within surgery types. Results: Within surgery type, pre-surgery characteristics differed little between L and C (Table 1, top). Days to follow-up, and absolute and relative weight changes did not differ between L and C. Within L, 16% of SG patients and 20% of RYGB patients experienced virtual (telemedicine) visits with bariatric clinicians during follow-up, compared to 0.6% in Group C. Conclusion: We detected no effect of 63 days of COVID lockdown on measures of weight change at 1 year post SG or RYGB. Telemedicine visits may be useful to maintain/improve clinical management of surgical weight loss during suspension of live health services.

Enhanced home health after bariatric surgery supports patient access and reduces length of stay and variable costs during COVID

Peter Ng Raleigh NC1, Afton Carducci Raleigh NC1, Lindsey Sharp Raleigh NC1, Dustin Bermudez Raleigh NC1, Linda Youngwirth Durham NC1, Tricia Burns Raleigh NC1, Erica McKearney Raleigh NC1, Lauren Massey Raleigh NC2 UNC Rex Bariatric Specialist1 UNC REX Hospital2 Introduction: The COVID-19 pandemic stressed inpatient hospital capacity and restricted elective surgery, limiting bariatric access. A novel outpatient home health program was introduced to support early discharge after bariatric surgery and preserve inpatient healthcare resources for COVID. This retrospective study evaluates the clinical/financial impact of enhanced home health in early post-operative bariatric recovery. Methods: Our program offered enhanced home health (EHH) to all bariatric patients with insurance inclusion. Patients were separated into 3 care tiers based on BMI and comorbidity with each tier adding complementary services. Tier 1 provided home intravenous hydration, anti-emetics x 3 days, and home nursing care. Tier 2 (BMI>50 kg/m2) added physical therapy. Tier 3 (plus comorbidity) added virtual primary care medical consultation. Patients were planned for scheduled discharge on post-operative day one by 10 am, if deemed medically appropriate. Results: From December to June 2021, 355 bariatric cases were performed, 158 non-EHH patients and 197 EHH patients with the following combined case mix: duodenal switch (54.6%), revision (17.2%), sleeve gastrectomy (16.6%), SADI-S (7.7%), and Roux-en-Y gastric bypass (3.9%). The prior year average hospital length of stay (LOS) was 2.0 days, non-EHH LOS of 2.0 days, versus EHH LOS of 1.5 days. A 6% reduction in direct variable costs per case was demonstrated, $9607 non-EHH versus $9036 EHH. Comparative readmission rates for nausea/vomiting/dehydration (NVD) equaled 3.8% for non-EHH and 1.5% for EHH patients. Conclusion: Enhanced home health preserved access to bariatric care while decreasing length of stay, variable costs, and reduced readmission for NVD.

The Impact of COVID-19 Pandemic on Access to Bariatric Surgery

Katherine Ho Tucson AZ1, Chiu-Hsieh Hsu Tucson AZ1, Yazan Ashouri Tucson AZ1, Saad Ajmal Tucson AZ1, Iman Ghaderi Tucson AZ1 University of Arizona1 Introduction: The COVID-19 pandemic had affected the health systems across the world since early 2020 with a concern about access to medical care during the first wave of COVID-19 pandemic. The aim of this study was to examine the effect of COVID-19 on the patient selection for elective bariatric surgery using Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Methods: MBSAQIP data for 2016-2020 was queried. Log-normal regression was performed to evaluate patient characteristics. Comparison between cases performed in 2020 and previous years was derived using Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables for laparoscopic vs. robotic-assisted approaches. Results: A total of 822,558 patients underwent robotic (R) and laparoscopic (L) sleeve gastrectomy and Roux-en-Y gastric-bypass (R-SG, L-SG, R-RYGB, and L-RYGB, respectively). Comorbidities were lower in the cases performed in 2020 compared to pre-COVID years in both the laparoscopic and robotic approaches of SG and RYGB. Conclusion: Patients who underwent elective bariatric surgery during COVID-19 pandemic in 2020 tend to have less comorbidities comparing to the patients who had bariatric surgery prior to COVID-19. It is possible that bariatric centers decreased offering surgeries to high-risk patients.

The impact of COVID on revisional bariatric surgery trends: An analysis of the 2020 MBSAQIP database

Benjamin Clapp El Paso TX1, Omar Ghanem Rochester MN2, Pavlos Papasavas Hartford CT3, John Marr El Paso TX1, Jisoo Kim El Paso TX1, Wayne English Nashville TN4 Texas Tech HSC Paul Foster School of Med1 Mayo Clinic2 Hartford Hospital3 Vanderbilt University4 Background: Revisional bariatric surgery (RBS) is the third most common bariatric surgery performed in the United States. RBS is likely to increase with time and may soon surpass Roux-en-Y gastric bypass (RYGB) in volume. The Metabolic and Bariatric Surgery Quality Improvement and Accreditation Program (MBSAQIP) tracks bariatric cases. Our goal was to evaluate the MBSAQIP for revisional bariatric surgery trends. Methods: The 2020 MBSAQIP Participant Use File (PUF) was used to look at the number and type of RBS and compared to similar MBSAQIP data over the previous five years. All cases listed under the Revision tag were included in the analysis. Procedures considered included RYGB, sleeve gastrectomy (SG), adjustable gastric band (AGB), biliopancreatic diversion (BPD) and single anastomosis duodenoileal bypass (SADI). Descriptive statistics were used. Results: There were 197,812 cases reported in the PUF. Of these, 26,652 (13.5%) were revisions, conversions or reoperations. Stapled non emergent procedures dominated with 19,763. There were 4,291 SG conversions and 682 re-sleeves. There were 9,217 RYGB conversions and 3,221 revisions. There were 2,067 AGB revisions, 883 BPD revisions or conversions, and 424 SADI revisions or conversions. Conclusions: A 40.2% percent increase of RBS was seen from 2015 to 2019 but COVID was responsible for a 22.8% decrease in 2020. It is anticipated that RBS will resume its upward trend after the pandemic passes. AGB revisions have decreased, while SADI revisions have increased. The largest percentage of growth has been in SG conversions.

Postoperative pneumonia after bariatric surgery during the COVID-19 pandemic: a National Surgical Quality Improvement Program study.

BACKGROUND: During the COVID-19 pandemic, surgical centers had to weigh the benefits and risks of conducting bariatric surgery. Obesity increases the risk of developing severe COVID-19 infections, and therefore, bariatric surgery is beneficial. In contrast, surgical patients who test positive for COVID-19 have higher mortality rates. OBJECTIVE: This study investigates the national prevalence of postoperative pneumonia during the COVID-19 pandemic in the bariatric surgery population. SETTING: The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. METHODS: This is a cross-sectional study using the ACS-NSQIP database. The population of concern included patients who underwent sleeve gastrectomy and Roux-en-Y gastric bypass procedures. Information was extracted on rate of postoperative pneumonia and other 30-day complications between 2018 and 2020. RESULTS: All baseline characteristics were similar among patients who underwent bariatric surgery between 2018 and 2020. However, there was a 156% increase in postoperative pneumonia in 2020 compared with the previous year. Furthermore, despite the similar postoperative complication rates across the years, there was a statistically significant increase in all-cause mortality in 2020. The multivariate analysis showed that having surgery in 2020 was a statistically significant risk factor for pneumonia development postoperatively. CONCLUSIONS: This study showed a statistically significant increase in the prevalence of postoperative pneumonia during the COVID-19 pandemic among bariatric surgery patients. Surgical centers must continuously evaluate the risks associated with healthcare-associated exposure to COVID-19 and weigh the benefits of bariatric surgery.

2021 Owen H Wangensteen Scientific Forum of the American College of Surgeons

The proceedings contain 629 papers. The topics discussed include: barriers to Covid-19 vaccination in underserved minorities: impact of health care access and sociodemographic perspectives;concomitant cholecystectomy during initial bariatric surgery does not increase risk of postoperative complications or bile duct injuries;identifying behavioral facilitators to weight loss after bariatric surgery: are there differences between Medicaid and non-Medicaid patients?;impact of post-discharge phone calls on nonurgent hospital returns;laparoscopic heller myotomy is associated with fewer postoperative complications compared to the thoracoscopic approach: a NSQIP study;population-wide analysis of the effect of bariatric surgery on idiopathic intracranial hypertension in obese patients;reducing operating room inefficiencies via a novel surgical app shortens the duration of laparoscopic Roux-en-y gastric bypass;subtotal gastrectomy vs gastroenterostomy in duodenal obstruction secondary to peptic ulcer disease: results of a retrospective nationwide study;and enhanced recovery after bariatric surgery: further reduction in opioid use with the introduction of dexmedetomidine and transverse abdominis plane block.

Short-term Outcomes after Bariatric Surgery during the COVID-19 Pandemic

Background: Elective surgery, especially bariatric surgery, was stopped during the coronavirus disease-2019 (COVID-19) pandemic in the United Kingdom. Obesity is a major risk factor for COVID-19-related mortality. As the COVID-19 infection and mortality rates in Devon had been relatively low, bariatric procedures resumed with the necessary precautions in Plymouth with the easing of lockdown restrictions in mid-May. The aim of this study was to examine the outcome of bariatric surgery during the COVID-19 pandemic. Methods: Details of 38 patients, who underwent bariatric surgery between June 2020 and November 2020, were analyzed prospectively. All patients underwent a COVID-19 swab test 24–48 hours prior to the surgery. The primary outcome measure was COVID-19-related morbidity. Secondary outcomes were non-COVID-19-related morbidity, mortality, and weight loss at 6-week follow-up. Results: Thirty-eight patients [24 females;median age 51 (24–63) years, median body mass indices (BMI) at surgery 42.9 (32.4–62.5) kg/m2] underwent bariatric surgery. Thirty-seven patients were of White British ethnicity. No patient tested positive for COVID-19 pre-and postoperatively. No patient had any COVID-19-related morbidity or mortality. One patient developed a staple line bleed and returned to theater for relook laparoscopy and hemostasis. One patient developed an anastomotic leak and had a relook laparotomy for lavage and drain placement. The median length of hospital stay was 1 day. One patient was preplanned for intensive care admission and he stayed in a high dependency unit (HDU) for 1 day. All patients were followed up for 6 weeks and the median (range) excess weight loss (%EWL), at 6 weeks, was 24.4% (−0.9–53.6). Conclusion: Bariatric surgery can be performed safely in an area of low COVID-19 prevalence with the necessary precautions.

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.

Safety and feasibility of bariatric surgery without inpatient hospital admission-prospective study

Background: Delays from the COVID-19 pandemic led to increased surgical wait times. With ongoing bed pressures, we must safely maximize surgical volumes. We prospectively evaluated the feasibility and safety of bariatric surgery without inpatient hospital admission. Methods: We identified patients whose elective bariatric surgery we felt could be safely scheduled without inpatient admission to a surgical ward. Patients recovered in an 'overnight stay' perioperative area. Selection criteria excluded patients with revisional surgery, BMI≥55, insulin-dependent diabetes, or therapeutic anticoagulation. Data were collected on consecutive patients scheduled without admission between April and June 2021. Seven-day emergency department (ED) visits and readmissions were used to establish the safety of this intervention. Results: Of 47 patients scheduled for surgery without admission, 42 (89.4%) underwent Roux-en- Y gastric bypasses and 5 (10.6%) sleeve gastrectomies. Patients stayed between 16 and 23 hours, with a mean and median of just over 20 hours. Only 2 (4.3%) patients required admission to the surgical ward, but both were discharged on postoperative day 1 (POD1). Only 2(4.3%) patients had ED visits within 7 days postoperatively, and neither required admission. There were no complications, reoperations, or deaths. A control group of bariatric surgery patients with planned hospital admission per usual care is being analyzed for comparison. Conclusions: We demonstrated that bariatric surgery can be performed without inpatient hospital admission in select patients. We anticipate our controls will further confirm the safety of this endeavor. Optimizing resource utilization is crucial now, as hospitals recover from the pandemic and prepare for potential future waves.

Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center.

INTRODUCTION: Increased morbimortality in patients with COVID-19 infection who had undergone surgery has raised concerns about bariatric surgery safety during the current COVID-19 pandemic. Currently, there is scarce literature on safety outcomes after bariatric surgery during the COVID-19 pandemic. OBJECTIVES: To determine the risk of symptomatic COVID-19 infection and associated complications during the first 30 days after bariatric surgery. MATERIALS AND METHODS: Prospective observational cohort study including all patients who consecutively underwent primary bariatric surgery between August and December 2020. RESULTS: A total of 189 patients were included. Median age and BMI were 36 (17-70) years and 38 (35-41) kg/m2, respectively. Forty percent of patients were women (n = 76), 59.3% (n = 112) underwent sleeve gastrectomy (SG), and 40.7% (n = 77) underwent Roux-en-Y gastric bypass (RYGB). All surgeries were performed laparoscopically. The median length of postoperative stay was 2 (0-5) days. Postoperative COVID-19 infection was detected in two patients (1.1%): one patient was readmitted without the need of intermediate or ICU care, and the other was managed as an outpatient. Major complications occurred in three patients (1.6%); none of them was COVID-19 related. Two patients required an unplanned reoperation. No patient required intermediate or ICU care, no severe COVID-19 complications were observed, and no mortality was reported. CONCLUSION: Bariatric surgery can be safely performed during the ongoing pandemic, albeit a low risk of COVID-19 symptomatic infection. Rigorous perioperative COVID-19 institutional protocols are required to perform bariatric surgery safely during the current pandemic.

The COVID-19 Pandemic Did Not Affect Target Weight Loss 1 Year Post Bariatric Surgery.

BACKGROUND: Bariatric surgery is one of the most effective treatments for patients with severe and complex obesity. Lifestyle modifications in diet and exercise habits have long been important adjunct to the long-term success after bariatric surgery. The effect of the COVID-19 pandemic on the postoperative bariatric patient is not well understood. We sought to evaluate the impact the COVID-19 pandemic on postoperative weight loss at 1 year in a bariatric cohort. METHODS: All patients who underwent bariatric surgery from January 1, 2020, to March 12, 2020, were included. Patients who underwent bariatric surgery during the same period of the two preceding years (2018 and 2019) were included as control groups. Primary end point was %EBMIL at 1 year. A telephone survey was administered to all patients from 2020 to assess for their perception on the effects of the COVID-19 pandemic on weight loss. RESULTS: A total of 596 patients were included: 181 from 2020, 199 from 2019, and 216 from 2018. The response rate was 97% and 53.4% of patients reported that the lockdown affected their ability to lose weight. The %EBMIL at 1 year was 64.1%, 63.7%, and 68.1% for 2020, 2019, and 2018, respectively. There was no difference in weight loss at 1 year (p = 0.77) despite a decrease in exercise activity in those who had surgery just before the pandemic. CONCLUSION: There was no difference in target weight loss at 1 year in a cohort who underwent bariatric surgery before the pandemic.

Diagnosis of COVID-19 and the bariatric surgery population: a single center experience.

BACKGROUND: While many cases of the coronavirus disease 2019 (COVID-19) are mild, patients with underlying medical conditions such as hypertension (HTN), diabetes mellitus (DM), older age, and morbid obesity are at higher risk of hospitalization and death. These conditions are characteristic of patients eligible for bariatric surgery, many of whom underwent weight loss procedures in the months prior to cessation of elective surgery in March 2020. The effects of the virus on these high-risk patients who had increased healthcare exposure in the early days of the pandemic are currently unknown. OBJECTIVES: To describe the experience of patients who underwent bariatric surgery during the early evolution of the COVID-19 pandemic. METHODS: This is a cross-sectional study including patients from a single center who underwent bariatric surgery from January 1st, 2020 to March 18th, 2020. A database was created to analyze patients' demographics, operative variables, and postoperative outcomes. All patients were contacted and a telephone survey was completed to inquire about COVID-19 exposure, symptoms, and testing 30 days before and after surgery. RESULTS: A total of 190 patients underwent bariatric surgery during the study period. Laparoscopic sleeve gastrectomy was the most common procedure (71.6%). One hundred seventy-eight patients (93.7%) completed the telephone survey. Postoperatively, 19 patients (10.7%) reported COVID-19 compatible symptoms, and six patients (3.4%) went on to test positive for COVID-19. There were no COVID-19-related hospital admissions or mortalities in this population. CONCLUSIONS: Morbidly obese patients are at high risk of severe disease secondary to COVID-19, and those undergoing bariatric surgery during the evolution of the pandemic reported symptoms at a rate of 10.7% 30 days after the surgery. While none of these patients suffered severe COVID-19 disease, the temporal relationship of their symptomatology and increased exposure to the healthcare system as a result of their surgery suggest an increased risk of disease with elective surgery.