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.

The Effect of Covid-19 Pandemic on Current and Future Endoscopic Personal Protective Equipment Practices: A National Survey of 77 Endoscopists.

Introduction: The COVID-19 pandemic has raised awareness about the importance of personal protective equipment (PPE). We aimed to study and compare PPE practices among Canadian endoscopists before and after the COVID-19 pandemic. Methods: A 74-item questionnaire was emailed from June 2020 to September 2020 to practicing endoscopists in Canada. Survey questions collected basic demographics and differences between PPE practices pre- and post-COVID-19. PPE practices were categorized into four endoscopic procedure types including upper or lower endoscopy and diagnostic or interventional. Outcomes for specific procedures were reported as rates, with ranges shown when evaluating all procedure types together. Results: A total of 77 respondents completed the survey with the majority of respondents aged 40 to 49 (44%) and identifying as Gastroenterologists (70%). Gender was evenly split (49% females versus 51% males). In the pre-pandemic era, the majority of endoscopists wore gowns (91 to 94%) and all endoscopists wore gloves (100%). However, the majority of endoscopists did not wear surgical masks (21 to 31%), face shields (13 to 34%), eye protection (13 to 21%), hair protection (11 to 13%), or N95 respirators (2 to 3%). In the post-pandemic era, more surgeons plan on wearing face shields (33 to 47%, P = 0.001 to 0.045), goggles (38.5 to 58.7%, P < 0.001), hair protection (33 to 36%, P = 0.011 to 0.024), and a trend suggests more surgeons will wear surgical masks (51 to 61%, P = 0.163 to 0.333). More endoscopists also plan on wearing N95 respirators during lower endoscopy (6 to 7%, P < 0.005). Conclusion: The COVID-19 pandemic has changed the attitudes of many endoscopists regarding future PPE use in routine endoscopy. Ongoing studies are needed to inform new post-pandemic PPE consensus guidelines.

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.