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1.
J Infect Chemother ; 28(3): 465-468, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1778294

ABSTRACT

Dalbavancin is a lipoglycopeptide antibiotic used off-label to treat serious gram-positive infections, including infections secondary to methicillin-resistant Staphylococcus aureus (MRSA). Dalbavancin has unique pharmacokinetic parameters and has a role in therapy for treating vulnerable patients, including intravenous drug users, who have challenges complying with typical care plans for serious infections. While there is data indicating successful clinical use of dalbavancin in patients with history of intravenous drug use as well as pharmacokinetic-pharmacodynamic data assessing dalbavancin in obesity, there is a lack of information regarding clinical effects of dalbavancin in patients with extreme obesity, especially in patients with concomitant drug use. This case report describes a 40-year-old morbidly obese female actively using intravenous drugs who developed prolonged MRSA bacteremia without a recognizable focus. Despite partial treatment with dalbavancin, the patient developed osteomyelitis and discitis of the spine with associated epidural phlegmon, likely complications of the MRSA bacteremia.


Subject(s)
Bacteremia , Methicillin-Resistant Staphylococcus aureus , Obesity, Morbid , Adult , Anti-Bacterial Agents/adverse effects , Bacteremia/drug therapy , Female , Humans , Obesity, Morbid/complications , Obesity, Morbid/drug therapy , Teicoplanin/adverse effects , Teicoplanin/analogs & derivatives
2.
JAMA Surg ; 157(3): 221-230, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1591201

ABSTRACT

Importance: Obesity is an established risk factor for severe COVID-19 infection. However, it is not known whether losing weight is associated with reduced adverse outcomes of COVID-19 infection. Objective: To investigate the association between a successful weight loss intervention and improved risk and severity of COVID-19 infection in patients with obesity. Design, Setting, and Participants: This cohort study involved adult patients with a body mass index of 35 or higher (calculated as weight in kilograms divided by height in meters squared) who underwent weight loss surgery between January 1, 2004, and December 31, 2017, at the Cleveland Clinic Health System (CCHS). Patients in the surgical group were matched 1:3 to patients who did not have surgical intervention for their obesity (control group). The source of data was the CCHS electronic health record. Follow-up was conducted through March 1, 2021. Exposures: Weight loss surgery including Roux-en-Y gastric bypass and sleeve gastrectomy. Main Outcomes and Measures: Distinct outcomes were examined before and after COVID-19 outbreak on March 1, 2020. Weight loss and all-cause mortality were assessed between the enrollment date and March 1, 2020. Four COVID-19-related outcomes were analyzed in patients with COVID-19 diagnosis between March 1, 2020, and March 1, 2021: positive SARS-CoV-2 test result, hospitalization, need for supplemental oxygen, and severe COVID-19 infection (a composite of intensive care unit admission, need for mechanical ventilation, or death). Results: A total of 20 212 patients (median [IQR] age, 46 [35-57] years; 77.6% female individuals [15 690]) with a median (IQR) body mass index of 45 (41-51) were enrolled. The overall median (IQR) follow-up duration was 6.1 (3.8-9.0) years. Before the COVID-19 outbreak, patients in the surgical group compared with control patients lost more weight (mean difference at 10 years from baseline: 18.6 [95% CI, 18.4-18.7] percentage points; P < .001) and had a 53% lower 10-year cumulative incidence of all-cause non-COVID-19 mortality (4.7% [95% CI, 3.7%-5.7%] vs 9.4% [95% CI, 8.7%-10.1%]; P < .001). Of the 20 212 enrolled patients, 11 809 were available on March 1, 2020, for an assessment of COVID-19-related outcomes. The rates of positive SARS-CoV-2 test results were comparable in the surgical and control groups (9.1% [95% CI, 7.9%-10.3%] vs 8.7% [95% CI, 8.0%-9.3%]; P = .71). However, undergoing weight loss surgery was associated with a lower risk of hospitalization (adjusted hazard ratio [HR], 0.51; 95% CI, 0.35-0.76; P < .001), need for supplemental oxygen (adjusted HR, 0.37; 95% CI, 0.23-0.61; P < .001), and severe COVID-19 infection (adjusted HR, 0.40; 95% CI, 0.18-0.86; P = .02). Conclusions and Relevance: This cohort study found that, among patients with obesity, substantial weight loss achieved with surgery was associated with improved outcomes of COVID-19 infection. The findings suggest that obesity can be a modifiable risk factor for the severity of COVID-19 infection.


Subject(s)
Bariatric Surgery , COVID-19 , Obesity, Morbid , Adult , COVID-19 Testing , Cohort Studies , Female , Humans , Male , Middle Aged , Obesity, Morbid/complications , Obesity, Morbid/epidemiology , Obesity, Morbid/surgery , SARS-CoV-2 , Weight Loss
3.
Int J Obes (Lond) ; 46(4): 750-757, 2022 04.
Article in English | MEDLINE | ID: covidwho-1575632

ABSTRACT

BACKGROUND: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. MATERIALS AND METHODS: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien-Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. RESULTS: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). CONCLUSIONS: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Gastric Bypass , Obesity, Morbid , COVID-19/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/surgery , Gastrectomy/adverse effects , Humans , Morbidity , Obesity, Morbid/complications , Obesity, Morbid/epidemiology , Obesity, Morbid/surgery , Propensity Score , Retrospective Studies , Treatment Outcome
4.
Aust Crit Care ; 35(1): 102-104, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1474345

ABSTRACT

Continuously rising numbers of obese critical care patients pose many challenges to the healthcare workers, especially during the COVID-19 pandemic. Among them, proning may be one of the most labour-intensive tasks. Prone positioning is performed manually in hospitals where mechanical lifting aids are unavailable; however, the exact method of manual proning is not explicitly described in the literature. Here, we present a case of a morbidly obese patient with COVID-19 pneumonitis in the intensive care unit with a step-by-step guide of the manual proning technique. Our approach is simple and feasible, as only readily available tools, such as bed sheets and friction-reducing sheets, are used.


Subject(s)
COVID-19 , Obesity, Morbid , Humans , Obesity, Morbid/complications , Pandemics , Patient Positioning , Prone Position , SARS-CoV-2
5.
Endoscopy ; 52(7): 537-547, 2020 07.
Article in English | MEDLINE | ID: covidwho-1454843

ABSTRACT

INTRODUCTION: Obesity is a known risk factor for gastroesophageal reflux disease (GERD), Barrett's esophagus (BE), and esophageal adenocarcinoma (EAC). Obese patients routinely undergo preoperative esophagogastroduodenoscopy (EGD) before bariatric procedures. We aimed to assess the prevalence of BE in this patient population. METHODS: We conducted a comprehensive literature search ending in March 2019. Search results were imported into covidence.org and screened by two independent reviewers. Heterogeneity was assessed using I 2 and Q statistics and publication bias using funnel plots and the Orwin fail-safe test. Random-effects modeling was used in all analyses. RESULTS : Of 4087 citations, 77 were reviewed in full text and 29 were included in the final analysis based on our predetermined inclusion/exclusion criteria. A total of 13 434 patients underwent pre-bariatric surgery EGD. The pooled prevalence of BE using random-effects modeling was 0.9 % (95 % confidence interval [CI] 0.7 % - 1.3 %); P < 0.001; I 2 = 58 %, Q = 67). In meta-regression analyses, controlling for sex and GERD, we found a positive association between mean body mass index (BMI) and the prevalence of BE (ß = 0.15 [95 %CI 0.02 - 0.28]; P = 0.03). A linear relationship between the prevalence of BE and the prevalence of GERD was also noted (ß = 3.9 [95 %CI 0.4 - 7.5]; P = 0.03). CONCLUSIONS : Obesity has been postulated as a major risk factor for BE, yet we found that the prevalence of BE in morbidly obese patients undergoing preoperative EGD was very low. Therefore, obesity alone may not be a major risk factor for BE.


Subject(s)
Bariatric Surgery , Barrett Esophagus , Esophageal Neoplasms , Obesity, Morbid , Barrett Esophagus/epidemiology , Humans , Obesity, Morbid/complications , Obesity, Morbid/epidemiology , Obesity, Morbid/surgery , Prevalence
6.
Eur Rev Med Pharmacol Sci ; 25(18): 5853-5856, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1451043

ABSTRACT

Coronavirus disease 2019-induced acute respiratory distress syndrome (ARDS) is more severe in morbidly obese patients. Mechanical ventilation differs between obese and non-obese patients. We examined these differences in an obese (body mass index = 47 kg/m2) 32-year-old patient followed up in our clinic. The patient was admitted to the intensive care unit due to respiratory failure. Recruitment maneuvers were performed in pressure-controlled ventilation mode. The optimal positive end-expiratory pressure was 25 cm H2O. The inspiratory pressure was adjusted to 45 cm H2O to provide a tidal volume of 6 ml/kg and driving pressure ≤ 15. The patient was discharged with full recovery.


Subject(s)
COVID-19/therapy , Obesity, Morbid , Respiration, Artificial/methods , Respiratory Distress Syndrome/therapy , Adult , COVID-19/blood , COVID-19/complications , COVID-19/diagnostic imaging , Humans , Intensive Care Units , Male , Obesity, Morbid/complications , Positive-Pressure Respiration/methods , Respiratory Distress Syndrome/complications , Tidal Volume
7.
J Surg Res ; 266: 35-43, 2021 10.
Article in English | MEDLINE | ID: covidwho-1349537

ABSTRACT

BACKGROUND: Bedside experience and studies of critically ill patients with coronavirus disease 2019 (COVID-19) indicate COVID-19 to be a devastating multisystem disease. We aim to describe the incidence, associated variables, and outcomes of rhabdomyolysis in critically ill COVID-19 patients. MATERIALS AND METHODS: Data for all critically ill adult patients (≥18 years old) admitted to the ICU at a large academic medical center with confirmed COVID-19 between March 13, 2020 and April 18, 2020 were prospectively collected. Patients with serum creatine kinase (CK) concentrations greater than 1000 U/L were diagnosed with rhabdomyolysis. Patients were further stratified as having moderate (serum CK concentration 1000-4999 U/L) or severe (serum CK concentration ≥5000 U/L) rhabdomyolysis. Univariate and multivariate analyses were performed to identify outcomes and variables associated with the development of rhabdomyolysis. RESULTS: Of 235 critically ill COVID-19 patients, 114 (48.5%) met diagnostic criteria for rhabdomyolysis. Patients with rhabdomyolysis more often required mechanical ventilation (P < 0.001), prone positioning (P < 0.001), pharmacological paralysis (P < 0.001), renal replacement therapy (P = 0.010), and extracorporeal membrane oxygenation (ECMO) (P = 0.025). They also had longer median ICU length of stay (LOS) (P < 0.001) and hospital LOS (P < 0.001). No difference in mortality was observed. Male sex, patients with morbid obesity, SOFA score, and prone positioning were independently associated with rhabdomyolysis. CONCLUSIONS: Nearly half of critically ill COVID-19 patients in our cohort met diagnostic criteria for rhabdomyolysis. Male sex, morbid obesity, SOFA score, and prone position were independently associated with rhabdomyolysis.


Subject(s)
COVID-19/complications , Obesity, Morbid/epidemiology , Rhabdomyolysis/epidemiology , Aged , Body Mass Index , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Comorbidity , Creatine Kinase/blood , Critical Illness , Female , Hospital Mortality , Humans , Incidence , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Obesity, Morbid/complications , Obesity, Morbid/diagnosis , Organ Dysfunction Scores , Prone Position , Prospective Studies , Rhabdomyolysis/blood , Rhabdomyolysis/diagnosis , Rhabdomyolysis/etiology , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/isolation & purification , Sex Factors
8.
BMJ Case Rep ; 14(7)2021 Jul 26.
Article in English | MEDLINE | ID: covidwho-1327625

ABSTRACT

Anaesthesia for patients with severe lung fibrosis post COVID-19 infection requires special consideration. This is due to its propensity to cause perioperative anaesthetic catastrophe and possibility of cross infection among healthcare workers if not properly managed. This interesting article elaborates in detail the anaesthetic and surgical challenges in a morbidly obese patient who had a severe COVID-19 infection presenting for an elective spine surgery.


Subject(s)
COVID-19 , Obesity, Morbid , Elective Surgical Procedures , Humans , Obesity, Morbid/complications , Obesity, Morbid/surgery , SARS-CoV-2 , Spine/diagnostic imaging , Spine/surgery
10.
Ann R Coll Surg Engl ; 103(7): 524-529, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288677

ABSTRACT

INTRODUCTION: Because of the COVID-19 pandemic, numerous bariatric surgical units globally have halted weight loss surgery. Obesity itself has been shown to be a predictor of poor outcome in people infected with the virus. The aim of this study was to report our experience as a high-volume bariatric institution resuming elective weight loss surgery safely amidst emergency admissions of COVID-19-positive patients. METHODS: A standard operating procedure based on national guidance and altered to accommodate local considerations was initiated across the hospital. Data were collected prospectively for 50 consecutive patients undergoing bariatric surgery following recommencement of elective surgery after the first national lockdown in the UK. RESULTS: Between 28 June and 5 August 2020, a total of 50 patients underwent bariatric surgery of whom 94% were female. Median age was 41 years and median body mass index was 43.8 (interquartile range 40.0-48.8)kg/m2. Half of the patients (n = 25/50) underwent laparoscopic sleeve gastrectomy and half underwent Roux-en-Y gastric bypass (RYGB). Of these 50 patients, 9 (18%) had revisional bariatric surgery. Overall median length of hospital stay was 1 day, with 96% of the study population being discharged within 24h of surgery. The overall rate of readmission was 6% and one patient (2%) returned to theatre with an obstruction proximal to jejuno-jejunal anastomosis. None of the patients exhibited symptoms or tested positive for COVID-19. CONCLUSION: With appropriately implemented measures and precautions, resumption of bariatric surgery during the COVID-19 pandemic appears feasible and safe with no increased risk to patients.


Subject(s)
Bariatric Surgery/adverse effects , COVID-19/prevention & control , Elective Surgical Procedures/adverse effects , Obesity, Morbid/surgery , Postoperative Complications/epidemiology , Adult , Bariatric Surgery/standards , Bariatric Surgery/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing/standards , COVID-19 Testing/statistics & numerical data , Clinical Protocols/standards , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Elective Surgical Procedures/standards , Elective Surgical Procedures/statistics & numerical data , Enhanced Recovery After Surgery/standards , Feasibility Studies , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Obesity, Morbid/complications , Pandemics/prevention & control , Patient Readmission/statistics & numerical data , Postoperative Complications/etiology , Prospective Studies , Retrospective Studies , Risk Assessment/statistics & numerical data , SARS-CoV-2/isolation & purification , Surgery Department, Hospital/organization & administration , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data
11.
BMJ Case Rep ; 14(6)2021 Jun 08.
Article in English | MEDLINE | ID: covidwho-1262388

ABSTRACT

Tracheostomy is an aerosol-generating procedure and performing it in patients with COVID-19 requiring mechanical ventilation raises significant concerns of infection risk to healthcare workers. We herein report a case of tracheostomy in a critically ill patient with severe COVID-19 acute respiratory distress syndrome. This article depicts the use of personal protective equipment, highlighting the common challenges it presents and ways to address them.


Subject(s)
COVID-19 , Obesity, Morbid , Humans , Obesity, Morbid/complications , Personal Protective Equipment , SARS-CoV-2 , Tracheostomy
13.
Eur J Clin Microbiol Infect Dis ; 40(9): 1963-1974, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1217443

ABSTRACT

It has been demonstrated that obesity is an independent risk factor for worse outcomes in patients with COVID-19. Our objectives were to investigate which classes of obesity are associated with higher in-hospital mortality and to assess the association between obesity and systemic inflammation. This was a retrospective study which included consecutive hospitalized patients with COVID-19 in a tertiary center. Three thousand five hundred thirty patients were included in this analysis (female sex: 1579, median age: 65 years). The median body mass index (BMI) was 28.8 kg/m2. In the overall cohort, a J-shaped association between BMI and in-hospital mortality was depicted. In the subgroup of men, BMI 35-39.9 kg/m2 and BMI ≥40 kg/m2 were found to have significant association with higher in-hospital mortality, while only BMI ≥40 kg/m2 was found significant in the subgroup of women. No significant association between BMI and IL-6 was noted. Obesity classes II and III in men and obesity class III in women were independently associated with higher in-hospital mortality in patients with COVID-19. The male population with severe obesity was the one that mainly drove this association. No significant association between BMI and IL-6 was noted.


Subject(s)
COVID-19/therapy , Obesity, Morbid/therapy , Aged , Aged, 80 and over , Body Mass Index , COVID-19/complications , COVID-19/epidemiology , COVID-19/mortality , Female , Hospital Mortality , Hospitalization , Humans , Male , Middle Aged , New York City/epidemiology , Obesity, Morbid/complications , Obesity, Morbid/epidemiology , Obesity, Morbid/mortality , Retrospective Studies , Sex Factors , Treatment Outcome
14.
Monaldi Arch Chest Dis ; 91(2)2021 Apr 06.
Article in English | MEDLINE | ID: covidwho-1183944

ABSTRACT

Dear Editor, A 55-year-female, house wife, non-smoker, morbidly obese (BMI>35) with no other co-morbidities or pre-existing lung disease presented to the emergency room with complaints of highgrade fever, cough with minimal sputum, progressive breathlessness, streaky haemoptysis, and anorexia for the past 5 days. She was admitted in intensive care unit (ICU) for severe COVID-19 pneumonia three months back and had successfully recovered after 24 days of hospitalization....


Subject(s)
COVID-19/complications , Invasive Pulmonary Aspergillosis/complications , Antifungal Agents/therapeutic use , COVID-19/therapy , Coinfection , Critical Care , Female , Humans , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/drug therapy , Middle Aged , Obesity, Morbid/complications , SARS-CoV-2 , Treatment Outcome , Voriconazole/therapeutic use
15.
Obes Facts ; 14(2): 205-213, 2021.
Article in English | MEDLINE | ID: covidwho-1143096

ABSTRACT

BACKGROUND: The COVID-19 pandemic is spreading all over the world, particularly in developed countries where obesity is also widespread. There is a high frequency of increased BMI in patients admitted to intensive care for SARS-CoV-2 infection with a major severity in patients with an excess of visceral adiposity. Patients at risk of severe SARS-CoV-2 acute respiratory syndrome are characterised by the high prevalence of pre-existing diseases (high blood pressure and cardiovascular disease, diabetes, chronic respiratory disease, or cancer), most of them typically present in severely obese patients. Indeed, the biological role of adipose tissue in sustaining SARS-CoV-2 infection is not completely elucidated. SUMMARY: The forced isolation due to pandemic containment measures abruptly interrupted the rehabilitation programs to which many patients with severe obesity were enrolled. People affected by obesity, and especially those with severe obesity, should continue clinical rehabilitation programs, taking extra measures to avoid COVID-19 infection and reinforcing the adoption of preventive procedures. In this review, the available data on obesity and COVID-19 are discussed along with evidence-based strategies for maintaining the necessary continuous rehabilitation programs. Key Messages: Greater attention is needed for obese and severely obese patients in the face of the current COVID-19 pandemic, which represents a huge challenge for both patients and healthcare professionals. The adoption of new strategies to guarantee adequate and continuous multidisciplinary nutritional rehabilitation programs will be crucial to control the severity of SARS-CoV-2 infection in high-risk populations as well as the worsening of obesity-linked complications. Health authorities should be urged to equip hospitals with tools for the diffusion of telemedicine to maintain physician-patient communication, which is fundamental in chronic and complicated obese patients.


Subject(s)
COVID-19/epidemiology , Obesity, Morbid/complications , COVID-19/complications , Hospitalization , Humans , Obesity, Morbid/epidemiology , Pandemics , Risk Factors , SARS-CoV-2
16.
Endocrinol Diabetes Nutr (Engl Ed) ; 68(2): 123-129, 2021 Feb.
Article in English, Spanish | MEDLINE | ID: covidwho-1065062

ABSTRACT

Obesity is a chronic disease that leads to an increased risk of mortality and morbidity, and the impact of the COVID-19 pandemic may create a new health challenge. There is clear evidence showing that some biological and social factors associated with obesity involve an increased risk of COVID-19 infection, hospitalization, and greater severity compared to people with normal weight. Undoubtedly, obesity involves a low-grade proinflammatory state that produces a dysregulation of the immune system that compromises its ability to respond to respiratory infection by COVID-19 and so produces a worsening of the disease. In this review, the main epidemiological and pathophysiological data that associate obesity with COVID-19 are described.


Subject(s)
COVID-19/complications , Obesity, Morbid/complications , COVID-19/epidemiology , Disease Susceptibility , Global Health , Humans , Risk Factors
18.
Surg Endosc ; 36(1): 149-154, 2022 01.
Article in English | MEDLINE | ID: covidwho-1046779

ABSTRACT

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.


Subject(s)
Bariatric Surgery , COVID-19 , Gastric Bypass , Laparoscopy , Obesity, Morbid , Aged , Bariatric Surgery/adverse effects , Cross-Sectional Studies , Gastrectomy , Humans , Obesity, Morbid/complications , Obesity, Morbid/surgery , Pandemics , Postoperative Complications/epidemiology , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
19.
Horm Metab Res ; 53(2): 85-93, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1006362

ABSTRACT

Our aim was to assess the association between obesity and the risk of unfavourable outcomes (composite of severe disease and mortality) in inpatients with COVID-19. We conducted a systematic search of databases between December 2019 and 28th June 2020. Studies were included if they reported or allowed estimation of an odds ratio (OR) for unfavourable outcome in obese compared to non-obese patients hospitalised for COVID-19. Twenty cohort studies of 28 355 hospitalised patients with COVID-19 infection were included. Meta-analysis estimated a pooled OR of 2.02 (1.41-2.89, p<0.001) for an unfavourable outcome in obese versus non-obese patients when adjusted for age, sex and co-morbidities. When unadjusted for confounders, the OR for unfavourable outcomes was 1.25 (CI 1.07-1.45, p=0.005). An increased adjusted OR was also seen for death (OR 1.51; CI 1.13-2.21, p=0.006) and severe illness (OR 2.26; CI 1.47-3.48, p<0.001). Compared to a normal BMI, the risk of an unfavourable outcome was increased even in overweight patients, with severe obesity having an escalated risk.Obesity is independently associated with an unfavourable outcome of COVID-19 illness, with obese patients having twice the risk of a composite outcome of severe disease or mortality, and a 50% increased risk of death.


Subject(s)
COVID-19/complications , COVID-19/therapy , Obesity/complications , COVID-19/mortality , Humans , Obesity, Morbid/complications , Overweight/complications , Risk Factors , Treatment Outcome
20.
Obesity (Silver Spring) ; 29(1): 29-37, 2021 01.
Article in English | MEDLINE | ID: covidwho-963739

ABSTRACT

OBJECTIVES: This study analyzed the association between severe obesity and coronavirus disease 2019 (COVID-19) hospitalization and severe disease. METHODS: The incidence of hospitalization for laboratory-confirmed COVID-19 was evaluated in a prospective population-based cohort of 433,995 persons aged 25 to 79 years in Spain during March and April of 2020. Persons with and without class 3 obesity were compared using Poisson regression to estimate the adjusted relative risk (aRR) from class 3 obesity of COVID-19 hospitalization and of severe disease (intensive care unit admission or death). Differences in the effect by age, sex, and chronic conditions were evaluated. RESULTS: Individuals with class 3 obesity had a higher risk of hospitalization (aRR = 2.20, 95% CI: 1.66-2.93) and developing severe COVID-19 (aRR = 2.30, 95% CI: 1.20-4.40). In people younger than 50 years, these effects were more pronounced (aRR = 5.02, 95% CI: 3.19-7.90 and aRR = 13.80, 95% CI: 3.11-61.17, respectively), whereas no significant effects were observed in those aged 65 to 79 years (aRR = 1.22, 95% CI: 0.70-2.12 and aRR = 1.42, 95% CI: 0.52-3.88, respectively). Sex and chronic conditions did not modify the effect of class 3 obesity in any of the outcomes. CONCLUSIONS: Severe obesity is a relevant risk factor for COVID-19 hospitalization and severity in young adults, having a magnitude similar to that of aging. Tackling the current obesity pandemic could alleviate the impact of chronic and infectious diseases.


Subject(s)
COVID-19/epidemiology , Hospitalization , Obesity, Morbid/epidemiology , Adult , Aged , Body Mass Index , COVID-19/complications , Female , Humans , Incidence , Intensive Care Units , Male , Middle Aged , Obesity, Morbid/complications , Pandemics , Prospective Studies , Risk Factors , SARS-CoV-2 , Spain/epidemiology
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