Global 30-day outcomes after bariatric surgery during the COVID-19 pandemic (GENEVA): an international cohort study

Bariatric and metabolic surgery (BMS) is the most effective intervention available for weight loss. However, high morbidity mortality associated with perioperative COVID-191COVIDSurg CollaborativeMortality pulmonary complications in patients undergoing SARS-CoV-2 infection: an international cohort study.Lancet. 2020; 396: 27-38Summary Full Text PDF PubMed Scopus (1050) Google Scholar has led to cancellation of millions surgeries including BMS procedures. There are also concerns that obesity treatment, BMS, might be especially overlooked COVID-19 recovery era due stigma,2Le Brocq S Clare K Bryant M Roberts Tahrani A on behalf writing group from Obesity UKthe Empowerment Networkthe UK Association Study ObesityObesity COVID-19: a call action people living obesity.Lancet Diabetes Endocrinol. 8: 652-654Summary (33) leading community develop recommendations management candidates context COVID-19.3Rubino F Cohen RV Mingrone G et al.Bariatric during after pandemic: DSS surgical postoperative prioritisation access surgery.Lancet 640-648Summary (113) paucity data safety performed pandemic once had become established recognised. Therefore, we did study (GENEVA) investigate 30-day primary done adults (?18 years) between May 1 July 10, 2020. Complications were recorded by use Clavien-Dindo (CD) classification system, which widely regarded as accepted method reporting complications. Detailed methods described appendix (pp 2–5). 2116 adult 133 hospitals 38 countries underwent period. Of these, 2001 (94·6%) patients, 218 surgeons at 127 35 countries, complete Aug 15, 2020 (appendix p 6). included 12 their peak incidence before 1, (883 [44·1%]); another collection period (811 [40·5%]); remaining 11 (ie, end follow up; 307 [15·3%]; 7). Baseline demographic clinical characteristics types summarised 8). was one death (18 days surgery) patient who leak following sleeve gastrectomy (SG). This negative. At 30 days, 138 reported 137 (6·8%) ten cases (table). Most (n=83 [60·6%]) mild (CD grade I or II). Patients developed tended older more likely current ex-smokers (vs non-smokers). Fewer occurred experienced 9).Table30-day all bariatric procedureAll (n=2001)SG (n=1142 [57%])RYGB (n=557 [28%])OAGB (n=215 [11%])Other*Other procedures listed 12. (n=87 [4%])Complications CD system gradeAll complications137 (6·8%)65 (5·7%)47 (8·4%)19 (8·8%)6 (6·9%)CD grades II83 (4·1%)41 (3·6%)29 (5·2%)8 (3·7%)5 (5·7%)CD III, IV, V54 (2·7%)24 (2·1%)18 (3·2%)11 (5·1%)1 (1·1%)CD I42 (2·1%)20 (1·8%)17 (3·1%)3 (1·4%)2 (2·3%)CD II41 (2·0%)21 (1·8%)12 (2·2%)5 (2·3%)3 (3·4%)CD IIIa10 (0·5%)3 (0·3%)3 (0·5%)4 (1·9%)0CD IIIb29 (1·4%)14 (1·2%)9 (1·6%)6 (2·8%)0CD IVa12 (0·6%)5 (0·4%)6 (1·1%)1 (0·5%)0CD IVb2 (0·1%)1 (0·1%)001 V (death)1 (0·05%)1 (0·1%)000COVID-19Symptomatic COVID-1910 (0·5%)8 (0·7%)1 (0·2%)01 (1·1%)Specific complicationsBleeding36 (1·8%)19 (1·7%)11 (2·0%)6 (2·8%)0Leak gastrointestinal tract16 (0·8%)9 (0·8%)2 (0·4%)5 (2·3%)0Wound infection10 (0·4%)4 (0·7%)02 (2·3%)Postoperative pneumonia (not otherwise specified)5 (0·2%)04 (0·5%)0Deep vein thrombosis1 (0·1%)000Pulmonary embolism1 (0·1%)000Other†Other 12.59 (2·9%)24 (2·1%)25 (4·5%)7 (3·3%)3 (3·4%)Data number (%) least specified event; if than complication, highest score reported. Data include adverse events time up 30-days postoperatively. SG=sleeve gastrectomy. RYGB= Roux-en-Y gastric bypass. OAGB=one-anastomosis CD=Clavien-Dindo.* Other 12.† Open table new tab CD=Clavien-Dindo. (0·5%) symptomatic diagnosed follow-up. These Egypt (n=4), Brazil (n=2), Mexico Argentina (n=1), India (n=1; 10). Eight these (Brazil, Egypt, Mexico) Two no preoperative testing SARS-CoV-2, seven required none needed intensive care ventilation, died. 1593 (79·6%) some COVID-19. Perioperative protocols place (p11). The overall 0·05% (1/2001) seen this consistent pre-pandemic figures studies (0·04–0·1%)4Poelemeijer YQM Liem RSL Våge al.Gastric bypass versus gastrectomy: selection short-term outcome 47,101 operations Swedish, Norwegian, Dutch national quality registries.Ann Surg. 272: 326-333Crossref (27) Scholar, 5Benotti P Wood GC Winegar DA al.Risk factors surgery.Ann 2014; 259: 123-130Crossref (102) 6Stenberg E Szabo Ågren al.Closure mesenteric defects laparoscopic bypass: multicentre, randomised, parallel, open-label trial.Lancet. 2016; 387: 1397-1404Summary (167) about 0·1% (1/1142) SG similar figure 29 588 patients.7Alizadeh RF Li Gambhir al.Laparoscopic syndrome: MBSAQIP analysis.Am 2019; 85: 1108-1112Crossref In recent systematic review,8Hu Z Sun J R al.A comprehensive comparison LRYGB LSG obese effects QoL, comorbidities, loss, complications: review meta-analysis.Obes 30: 819-827Crossref (29) 10·1% (319/3155) (RYGB) 5·4% (155/2876) SG, rates our (8·4% 5·7%, respectively; table). Similarly, Stenberg colleagues6Stenberg 7·8% (196/2503) RYGB.6Stenberg severe V) RYGB (3·2% 2·1%, table) those previous studies.4Poelemeijer 7Alizadeh COVID-19, ventilation died; II finding contrasts COVIDSurg Collaborative,1COVIDSurg half various emergency elective 23·8%. striking difference particularly notable given increased risk so compared other patients. unlike study, analysis assessed early local well established, help account lower study. Another important factor regard timing It possible individuals have worse prognosis do disease several later. Our variable relation Local heterogeneity prevalence contributed small among Notably, few widespread As such, believe low reflective presence efficacy protocols. Because potential gap becoming infected developing symptoms, requiring outcomes, there possibility outcomes not been captured population (due obesity, diabetes, hypertension, cardiovascular disease) median incubation 4 days. it identified majority population. Unsurprisingly, RYGB, one-anastomosis accounted 95% procedures, keeping last two International Federation Surgery Metabolic Disorders (IFSO) global reports.9Welbourn Hollyman Kinsman worldwide: baseline description one-year fourth IFSO Global Registry report 2018.Obes 29: 782-795Crossref (387) 10Angrisani L Santonicola Iovino al.IFSO worldwide survey 2016: primary, endoluminal, revisional procedures.Obes 2018; 28: 3783-3794Crossref (591) mean BMI 42·4 kg/m2 41·7 registry report.9Welbourn Although cannot rule out bias caused health-care professionals choosing lower-risk view pandemic, studies.9Welbourn limitations. only participating centres therefore represent picture. Furthermore, although ensured collaborators knew importance submitting consecutive period, certain contributors followed instruction. does control statistical comparison. contemporary would because scale comparing aim Besides, comparisons challenging considering different BMS. An ideal collect through same approach unpredictability fast spread strengths large sample size, reach completion rate, extensive profiling. Additionally, represented phases across (before, during, peak). conclusion, showed locally appropriate seemed levels. evolving situation, teams need continually monitor data. We declare competing interests. RS KM concept AAT responsible collection, conduct, analysis, CL prepared figure, authors revising report. funded research funds unit University Hospitals Birmingham NHS Foundation Trust (Birmingham, UK). Download .pdf (2.66 MB) Help pdf files Supplementary