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Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery.
Rubino, Francesco; Cohen, Ricardo V; Mingrone, Geltrude; le Roux, Carel W; Mechanick, Jeffrey I; Arterburn, David E; Vidal, Josep; Alberti, George; Amiel, Stephanie A; Batterham, Rachel L; Bornstein, Stefan; Chamseddine, Ghassan; Del Prato, Stefano; Dixon, John B; Eckel, Robert H; Hopkins, David; McGowan, Barbara M; Pan, An; Patel, Ameet; Pattou, François; Schauer, Philip R; Zimmet, Paul Z; Cummings, David E.
  • Rubino F; Department of Diabetes, School of Life Course Sciences, King's College London, London, UK; Bariatric and Metabolic Surgery, King's College Hospital, London, UK. Electronic address: francesco.rubino@kcl.ac.uk.
  • Cohen RV; Center for the treatment of Obesity and Diabetes, Oswaldo Cruz German Hospital, Sao Paulo, Brazil.
  • Mingrone G; Department of Diabetes, School of Life Course Sciences, King's College London, London, UK; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
  • le Roux CW; Diabetes Complications Research Centre, Conway Institute, University College of Dublin, Dublin, Ireland.
  • Mechanick JI; The Marie-Josee and Henry R Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, NY, USA; Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • Arterburn DE; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
  • Vidal J; Endocrinology and Nutrition Department, Hospital Clinic Universitari, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.
  • Alberti G; Department of Endocrinology and Metabolism, Imperial College, London, UK.
  • Amiel SA; Department of Diabetes, School of Life Course Sciences, King's College London, London, UK.
  • Batterham RL; Centre for Obesity Research, University College London, London, UK; University College London Hospitals Bariatric Centre for Weight Management and Metabolic Surgery, London, UK; National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK.
  • Bornstein S; Paul Langerhans Institute Dresden, Helmholtz Center Munich at the University Hospital Carl Gustav Carus and Faculty of Medicine, Technical University Dresden, Dresden, Germany.
  • Chamseddine G; Bariatric and Metabolic Surgery, King's College Hospital, London, UK.
  • Del Prato S; Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy.
  • Dixon JB; Iverson Health Innovation Research Institute, Swinburne University, Melbourne, VIC, Australia.
  • Eckel RH; Division of Endocrinology, Metabolism and Diabetes and Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
  • Hopkins D; King's Health Partners' Institute of Diabetes, Endocrinology and Obesity, London, UK.
  • McGowan BM; Institute of Diabetes, Endocrinology and Obesity, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
  • Pan A; Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
  • Patel A; Bariatric and Metabolic Surgery, King's College Hospital, London, UK.
  • Pattou F; European Genomic Institute for Diabetes, Lille, France; Translational Research for Diabetes, University of Lille, Inserm, Centre Hospitalier Regional Universitaire, Lille, France.
  • Schauer PR; Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
  • Zimmet PZ; Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
  • Cummings DE; University of Washington Medicine Diabetes Institute, University of Washington, Seattle, WA, USA; Weight Management Program, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, WA, USA.
Lancet Diabetes Endocrinol ; 8(7): 640-648, 2020 07.
Article in English | MEDLINE | ID: covidwho-197827
ABSTRACT
The coronavirus disease 2019 pandemic is wreaking havoc on society, especially health-care systems, including disrupting bariatric and metabolic surgery. The current limitations on accessibility to non-urgent care undermine postoperative monitoring of patients who have undergone such operations. Furthermore, like most elective surgery, new bariatric and metabolic procedures are being postponed worldwide during the pandemic. When the outbreak abates, a backlog of people seeking these operations will exist. Hence, surgical candidates face prolonged delays of beneficial treatment. Because of the progressive nature of obesity and diabetes, delaying surgery increases risks for morbidity and mortality, thus requiring strategies to mitigate harm. The risk of harm, however, varies among patients, depending on the type and severity of their comorbidities. A triaging strategy is therefore needed. The traditional weight-centric patient-selection criteria do not favour cases based on actual clinical needs. In this Personal View, experts from the Diabetes Surgery Summit consensus conference series provide guidance for the management of patients while surgery is delayed and for postoperative surveillance. We also offer a strategy to prioritise bariatric and metabolic surgery candidates on the basis of the diseases that are most likely to be ameliorated postoperatively. Although our system will be particularly germane in the immediate future, it also provides a framework for long-term clinically meaningful prioritisation.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Postoperative Care / Coronavirus Infections / Bariatric Surgery / Pandemics / Betacoronavirus / Obesity Type of study: Observational study / Prognostic study Limits: Humans Language: English Journal: Lancet Diabetes Endocrinol Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Postoperative Care / Coronavirus Infections / Bariatric Surgery / Pandemics / Betacoronavirus / Obesity Type of study: Observational study / Prognostic study Limits: Humans Language: English Journal: Lancet Diabetes Endocrinol Year: 2020 Document Type: Article