key: cord-0823325-jca6262q
authors: Altieri, Maria S.
title: Comment on: Prior bariatric surgery in COVID-19 positive patients may be protective
date: 2021-09-04
journal: Surg Obes Relat Dis
DOI: 10.1016/j.soard.2021.08.026
sha: 780023dec4a735494709ebb8dcf157a35dfaf8ca
doc_id: 823325
cord_uid: jca6262q

nan

In this issue of Surgery of Obesity and Related Diseases , the manuscript titled "Prior bariatric surgery in COVID-19 positive patients may be protective" reports a retrospective review of patients utilizing a COVID-19 database from a single, New York City based academic institution which compared two groups: a bariatric surgery group (n=124) and a control group comprised from patients eligible for bariatric surgery [1] . The bariatric surgery group comprised of Roux-en-Y Gastric Bypass (RYGB) (n=45, 36%), laparoscopic Sleeve Gastrectomy (LSG) (n=35, 28%) and laparoscopic adjustable gastric banding (LAGB) (n=44, 35%). The two groups were compared in terms of mechanical ventilation requirements, in hospital deaths, intensive care unit (ICU) stay and hospital length of stay (HLOS). The bariatric group had a significantly lower Body Mass Index (BMI) of 36.1 kg/m2 (SD 8.3) compared to 41.4kg/m3 (SD 6.5) in the control group. Patients in the bariatric group were less likely to be admitted, less likely to require mechanical ventilation, had shorter ICU stay and HLOS (p<0.05). After adjusting for BMI and obesity-related comorbidities, patients with a history of bariatric surgery had a significant decrease in the risk of ED admissions.

Novel coronavirus disease, COVID-19, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is highly virulent virus, which has caused an unprecedented global crisis. Since the pandemic began, obesity and impaired metabolic health have emerged as leading risk factors for worse outcomes associated with COVID-19 infection [2] [3] [4] [5] . A recent metaanalysis demonstrated that obese patients (BMI >/=30 kg/m2) were at 46% higher risk of developing COVID-19, but also were 113% more likely to be hospitalized, 74% higher risk for ICU admission, and 48% higher risk of death [6] . As of 2019, the Center for Disease Control and Prevention reports that 31.4% and 15.5% of US adults and adolescents, respectively, are J o u r n a l P r e -p r o o f considered obese in the United States [7] . Thus, it seems vital to create strategies to combat obesity, which is already associated with many other chronic and debilitating conditions.

With another wave of COVID-19 infections on the rise, many institutions are postponing non emergent surgical procedures. As bariatric surgery has been widely established as the most effective and durable treatment for severe obesity and the growing evidence of the association between BMI and worse outcomes, the question remains: should bariatric surgery be considered an elective procedure?

This pandemic has highlighted the vulnerabilities of patients with obesity and the necessity of creating better strategies for the management of this chronic, but modifiable, disease process.

The current manuscript adds to the growing evidence that bariatric/metabolic surgery is associated with improved outcomes and decreasing severity of COVID-19 infections in the obese population [8] . The mechanism through which surgery leads to decreased worse outcomes is not completely elucidated. Perhaps the anti-inflammatory effects of surgery counteracts the proinflammatory state of the COVID-19 infection, as surgery leads to a reduction in excessive adipose tissue, in addition to improving some of the obesity-related co-morbidities. Based on this data, the American Society of Metabolic and Bariatric surgery argues that by addressing obesity in the country in an expeditious manner, metabolic surgery can be a life-saving procedure and given its substantial benefits, it should be considered an essential surgery, rather than an elective procedure [9] .

Prior bariatric surgery in COVID-19 positive patients may be protective

Association of obesity with postacute sequelae of COVID-19

Obesity is a risk factor for developing critical condition in COVID-19 patients: a systematic review and meta-analysis

Obesity and mortality of COVID-19. Meta-analysis

Obesity and impaired metabolic health in patients with COVID-19

Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships

Center for Disease Control and Prevention. Nutrition, Physical Activity, and Obesity:Data, Trends, and Maps

Association of prior metabolic and bariatric surgery with severity of coronavirus disease 2019 (COVID-19) in patients with obesity

Safer through surgery: American Society for Metabolic and Bariatric Surgery statement regarding metabolic and bariatric surgery during the COVID-19 pandemic