ASMBS: Bariatric surgery ‘medically necessary’ during COVID-19 pandemic
Bariatric surgery can improve obesity and the related diseases that increase risks for worse COVID-19 outcomes and should not be considered an elective procedure, according to the American Society for Metabolic and Bariatric Surgery.
Surgical treatment of obesity has been postponed in many parts of the world during the COVID-19 pandemic, and some states have included bariatric surgery in statewide orders as examples of “elective” procedures that should be the last to be restarted, the society wrote in a statement published in Surgery for Obesity and Related Diseases.
“Non-emergent surgeries have been shut down for good reason — so that hospitals can focus their resources and personnel on the impending crises. However, as the crisis situation recedes, but risks for COVID-19 persist, we must be thoughtful of when and how to resume,” Matthew Hutter, MD, MBA, MPH, professor of surgery at Harvard Medical School and president of the American Society for Metabolic and Bariatric Surgery (ASMBS), told Healio. “We want people to think about when it might be safe to restart bariatric surgery and the important local factors to consider in making that decision. If you put bariatric surgery into that elective category, patients may not get treatment that is lifesaving and life improving for them.”
In the statement, ASMBS wrote that bariatric surgery is “not elective,” noting the procedure is “medically necessary and the best treatment for those with the life-threatening and life-limiting disease of severe obesity.”
The statement was a response to an editorial published in Obesity Surgery by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), which stated that all elective surgical and endoscopic cases for metabolic and bariatric surgery should be postponed during the pandemic.
“The ASMBS disagrees with the concept that bariatric surgery should be postponed until the pandemic is over,” the society wrote in the statement. “The global nature of the pandemic, the potential for a second wave or persistent ongoing infection in some parts of the world, along with more traditional risks, such as annual influenza outbreaks, make postponement potentially indefinite.”
Hutter said the society wants to balance the need for potentially lifesaving obesity treatment with local conditions, the level of community spread, and testing ability.
“All of that is critical,” Hutter said. “However, just because COVID-19 is still out there, that does not mean we should not be doing this type of surgery.”
Obesity can be an independent risk factor for worse COVID-19 complications. As Healio previously reported, some of the most severe complications of COVID-19 — namely, acute respiratory failure or acute respiratory distress syndrome — can be driven by conditions already present in a person with obesity, such as chronic, low-grade inflammation and hypoventilation.
Bariatric surgery is safe and effective, as well as minimally invasive with low complication rates, Hutter said.
“There is more data all the time that shows obesity puts patients at increased risk for more severe COVID-19 complications,” Hutter said. “Obesity is also related to many obesity-related diseases, including diabetes, hypertension, hyperlipidemia, which all independently put you at increased risk for these complications. Obesity is a menacing disease, and not many people recognize it as such. Patients with severe obesity are safer through surgery.”
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Matthew Hutter, MD, can be reached at firstname.lastname@example.org; Twitter: @ASMBS.