30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries

Singhal, R.; Ludwig, C.; Rudge, G.; Gkoutos, G. V.; Tahrani, A.; Mahawar, K.; Pedziwiatr, M.; Major, P.; Zarzycki, P.; Pantelis, A.; Lapatsanis, D. P.; Stravodimos, G.; Matthys, C.; Focquet, M.; Vleeschouwers, W.; Spaventa, A. G.; Zerrweck, C.; Vitiello, A.; Berardi, G.; Musella, M.; Sanchez-Meza, A.; Cantu, F. J.; Mora, F.; Cantu, M. A.; Katakwar, A.; Reddy, D. N.; Elmaleh, H.; Hassan, M.; Elghandour, A.; Elbanna, M.; Osman, A.; Khan, A.; Layani, L.; Kiran, N.; Velikorechin, A.; Solovyeva, M.; Melali, H.; Shahabi, S.; Agrawal, A.; Shrivastava, A.; Sharma, A.; Narwaria, B.; Narwaria, M.; Raziel, A.; Sakran, N.; Susmallian, S.; Karagoz, L.; Akbaba, M.; Piskin, S. Z.; Balta, A. Z.; Senol, Z.; Manno, E.; Iovino, M. G.; Osman, A.; Qassem, M.; Arana-Garza, S.; Povoas, H. P.; Vilas-Boas, M. L.; Naumann, D.; Super, J.; Li, A.; Ammori, B. J.; Balamoun, H.; Salman, M.; Nasta, A. M.; Goel, R.; Sanchez-Aguilar, H.; Herrera, M. F.; Abou-Mrad, A.; Cloix, L.; Mazzini, G. S.; Kristem, L.; Lazaro, A.; Campos, J.; Bernardo, J.; Gonzalez, J.; Trindade, C.; Viveiros, O.; Ribeiro, R.; Goitein, D.; Hazzan, D.; Segev, L.; Beck, T.; Reyes, H.; Monterrubio, J.; Garcia, P.; Benois, M.; Kassir, R.; Contine, A.; Elshafei, M.; Aktas, S.; Weiner, S.; Heidsieck, T.; Level, L.; Pinango, S.; Ortega, P. M.; Moncada, R.; Valenti, V.; Vlahovic, I.; Boras, Z.; Liagre, A.; Martini, F.; Juglard, G.; Motwani, M.; Saggu, S. S.; Al Moman, H.; Lopez, L. A. A.; Cortez, M. A. C.; Zavala, R. A.; D'Haese, C.; Kempeneers, I.; Himpens, J.; Lazzati, A.; Paolino, L.; Bathaei, S.; Bedirli, A.; Yavuz, A.; Buyukkasap, C.; Ozaydin, S.; Kwiatkowski, A.; Bartosiak, K.; Waledziak, M.; Santonicola, A.; Angrisani, L.; Iovino, P.; Palma, R.; Iossa, A.; Boru, C. E.; De Angelis, F.; Silecchia, G.; Hussain, A.; Balchandra, S.; Coltell, I. B.; Perez, J. L.; Bohra, A.; Awan, A. K.; Madhok, B.; Leeder, P. C.; Awad, S.; Al-Khyatt, W.; Shoma, A.; Elghadban, H.; Ghareeb, S.; Mathews, B.; Kurian, M.; Larentzakis, A.; Vrakopoulou, G. Z.; Albanopoulos, K.; Bozdag, A.; Lale, A.; Kirkil, C.; Dincer, M.; Bashir, A.; Haddad, A.; Hijleh, L. A.; Zilberstein, B.; de Marchi, D. D.; Souza, W. P.; Broden, C. M.; Gislason, H.; Shah, K.; Ambrosi, A.; Pavone, G.; Tartaglia, N.; Kona, S. L. K.; Kalyan, K.; Perez, C. E. G.; Botero, M. A. F.; Covic, A.; Timofte, D.; Maxim, M.; Faraj, D.; Tseng, L.; Liem, R.; Oren, G.; Dilektasli, E.; Yalcin, I.; Almukhtar, H.; Al Hadad, M.; Mohan, R.; Arora, N.; Bedi, D.; Rives-Lange, C.; Chevallier, J. -M.; Poghosyan, T.; Sebbag, H.; Zinai, L.; Khaldi, S.; Mauchien, C.; Mazza, D.; Dinescu, G.; Rea, B.; Perez-Galaz, F.; Zavala, L.; Besa, A.; Curell, A.; Balibrea, J. M.; Vaz, C.; Galindo, L.; Silva, N.; Caballero, J. L. E.; Sebastian, S. O.; Marchesini, J. C. D.; da Fonseca Pereira, R. A.; Sobottka, W. H.; Fiolo, F. E.; Turchi, M.; Coelho, A. C. J.; Zacaron, A. L.; Barbosa, A.; Quinino, R.; Menaldi, G.; Paleari, N.; Martinez-Duartez, P.; de Aragon Ramirez de Esparza, G. M.; Esteban, V. S.; Torres, A.; Garcia-Galocha, J. L.; Josa, M.; Pacheco-Garcia, J. M.; Mayo-Ossorio, M. A.; Chowbey, P.; Soni, V.; de Vasconcelos Cunha, H. A.; Castilho, M. V.; Ferreira, R. M. A.; Barreiro, T. A.; Charalabopoulos, A.; Sdralis, E.; Davakis, S.; Bomans, B.; Dapri, G.; Van Belle, K.; Takieddine, M.; Vaneukem, P.; Karaca, E. S. A.; Karaca, F. C.; Sumer, A.; Peksen, C.; Savas, O. A.; Chousleb, E.; Elmokayed, F.; Fakhereldin, I.; Aboshanab, H. M.; Swelium, T.; Gudal, A.; Gamloo, L.; Ugale, A.; Ugale, S.; Boeker, C.; Reetz, C.; Hakami, I. A.; Mall, J.; Alexandrou, A.; Baili, E.; Bodnar, Z.; Maleckas, A.; Gudaityte, R.; Guldogan, C. E.; Gundogdu, E.; Ozmen, M. M.; Thakkar, D.; Dukkipati, N.; Shah, P. S.; Shah, S. S.; Shah, S. S.; Adil, M. T.; Jambulingam, P.; Mamidanna, R.; Whitelaw, D.; Adil, M. T.; Jain, V.; Veetil, D. K.; Wadhawan, R.; Torres, A.; Torres, M.; Tinoco, T.; Leclercq, W.; Romeijn, M.; van de Pas, K.; Alkhazraji, A. K.; Taha, S. A.; Ustun, M.; Yigit, T.; Inam, A.; Burhanulhaq, M.; Pazouki, A.; Eghbali, F.; Kermansaravi, M.; Jazi, A. H. D.; Mahmoudieh, M.; Mogharehabed, N.; Tsiotos, G.; Stamou, K.; Barrera Rodriguez, F. J.; Rojas Navarro, M. A.; Torres, O. M. O.; Martinez, S. L.; Tamez, E. R. M.; Millan Cornejo, G. A.; Flores, J. E. G.; Mohammed, D. A.; Elfawal, M. H.; Shabbir, A.; Guowei, K.; J. B., So; Kaplan, E. T.; Kaplan, M.; Kaplan, T.; Pham, D. T.; Rana, G.; Kappus, M.; Gadani, R.; Kahitan, M.; Pokharel, K.; Osborne, A.; Pournaras, D.; Hewes, J.; Napolitano, E.; Chiappetta, S.; Bottino, V.; Dorado, E.; Schoettler, A.; Gaertner, D.; Fedtke, K.; Aguilar-Espinosa, F.; Aceves-Lozano, S.; Balani, A.; Nagliati, C.; Pennisi, D.; Rizzi, A.; Frattini, F.; Foschi, D.; Benuzzi, L.; Parikh, C.; Shah, H.; Pinotti, E.; Montuori, M.; Borrelli, V.; Dargent, J.; Copaescu, C. A.; Hutopila, I.; Smeu, B.; Witteman, B.; Hazebroek, E.; Deden, L.; Heusschen, L.; Okkema, S.; Aufenacker, T.; den Hengst, W.; Vening, W.; van der Burgh, Y.; Ghazal, A.; Ibrahim, H.; Niazi, M.; Alkhaffaf, B.; Altarawni, M.; Cesana, G. C.; Anselmino, M.; Uccelli, M.; Olmi, S.; Stier, C.; Akmanlar, T.; Sonnenberg, T.; Schieferbein, U.; Marcolini, A.; Awruch, D.; Vicentin, M.; de Souza Bastos, E. L.; Gregorio, S. A.; Ahuja, A.; Mittal, T.; Bolckmans, R.; Wiggins, T.; Baratte, C.; Wisnewsky, J. A.; Genser, L.; Chong, L.; Taylor, L.; Ward, S.; Chong, L.; Taylor, L.; M. W., Hi; Heneghan, H.; Fearon, N.; Plamper, A.; Rheinwalt, K.; Heneghan, H.; Geoghegan, J.; K. C., Ng; Fearon, N.; Kaseja, K.; Kotowski, M.; Samarkandy, T. A.; Leyva-Alvizo, A.; Corzo-Culebro, L.; Wang, C.; Yang, W.; Dong, Z.; Riera, M.; Jain, R.; Hamed, H.; Said, M.; Zarzar, K.; Garcia, M.; Turkcapar, A. G.; Sen, O.; Baldini, E.; Conti, L.; Wietzycoski, C.; Lopes, E.; Pintar, T.; Salobir, J.; Aydin, C.; Atici, S. D.; Ergin, A.; Ciyiltepe, H.; Bozkurt, M. A.; Kizilkaya, M. C.; Onalan, N. B. D.; Zuber, M. N. B. A.; Wong, W. J.; Garcia, A.; Vidal, L.; Beisani, M.; Pasquier, J.; Vilallonga, R.; Sharma, S.; Parmar, C.; Lee, L.; Sufi, P.; Sinan, H.; Saydam, M.

doi:10.1007/s11695-021-05493-9

Background: There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. Methods: We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. Results: Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. Conclusions: BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.