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Bariatric Surgical Practice During the Initial Phase of COVID-19 Outbreak
Ali Aminian1, Mohammad Kermansaravi2, Shahriar Azizi3
1Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk M61, Cleveland, OH, 44195, USA. aminiaa@ccf.org.
Insights
Coronavirus disease 2019 (COVID-19) can complicate bariatric surgery recovery. Early diagnosis and management are crucial for severe obesity patients undergoing gastric bypass surgery.
Area of Science:
- Bariatric Surgery
- Infectious Diseases
- Public Health
Background:
- Limited data exists on coronavirus disease 2019 (COVID-19) in patients with severe obesity post-bariatric surgery.
- Bariatric surgery is a common procedure for severe obesity, impacting patient health outcomes.
Purpose of the Study:
- To report on cases of COVID-19 in patients who underwent bariatric surgery.
- To highlight the challenges in diagnosing and managing COVID-19 in the postoperative setting.
Main Methods:
- Retrospective case series of four patients who underwent gastric bypass surgery between February 24 and March 4, 2020.
- Analysis of patient demographics, surgical procedures, COVID-19 symptom onset, and treatment protocols.
Main Results:
- Four gastric bypass patients developed COVID-19 within 14 days of surgery (mean age 46±12 years, BMI 49±3 kg/m²).
- Symptoms included fever, cough, dyspnea, and fatigue; one patient had pre-operative anosmia.
- Three patients required hospital readmission; all survived with varied treatments, including hydroxychloroquine and off-label therapies for ICU patients.
Conclusions:
- COVID-19 poses a significant complication risk in the postoperative period for bariatric surgery patients.
- The timing of infection suggests potential hospital transmission, emphasizing the need for stringent infection control measures.
- Effective diagnosis and management of COVID-19 in this vulnerable population require careful consideration.
Abstract:
There is no data on patients with severe obesity who developed coronavirus disease 2019 (COVID-19) after bariatric surgery. Four gastric bypass operations, performed in a 2-week period between Feb 24 and March 4, 2020, in Tehran, Iran, were complicated with COVID-19. The mean age and body mass index were 46 ± 12 years and 49 ± 3 kg/m2. Patients developed their symptoms (fever, cough, dyspnea, and fatigue) 1, 2, 4, and 14 days after surgery. One patient had unnoticed anosmia 2 days before surgery. Three patients were readmitted in hospital. All 4 patients were treated with hydroxychloroquine. In two patients who required admission in intensive care unit, other off-label therapies including antiretroviral and immunosuppressive agents were also administered. All patients survived. In conclusion, COVID-19 can complicate the postoperative course of patients after bariatric surgery. Correct diagnosis and management in the postoperative setting would be challenging. Timing of infection after surgery in our series would raise the possibility of hospital transmission of COVID-19: from asymptomatic patients at the time of bariatric surgery to the healthcare workers versus acquiring the COVID-19 infection by non-infected patients in the perioperative period.
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