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Disclosures: The authors report no relevant financial disclosures.
December 21, 2020
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Prior bariatric surgery may reduce COVID-19 severity

Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.
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Adults with obesity who tested positive for COVID-19 were significantly less likely to experience severe disease complications if they had previous bariatric surgery, according to findings from a matched-cohort analysis.

“We know obesity is a major risk factor for COVID-19 severity, and we wanted to see if weight loss could modify the seriousness of COVID-19 infection,” Ali Aminian, MD, associate professor of surgery and director of the Bariatric and Metabolic Institute at Cleveland Clinic, told Healio. “We looked at patients who underwent bariatric surgery before a COVID-19 diagnosis, who lost substantial weight, experienced improved metabolic conditions and kept the weight off for a long period. We wanted to see if losing weight long term could improve the outcome.”

Aminian is an associate professor of surgery and director of the Bariatric and Metabolic Institute at Cleveland Clinic.

In a retrospective study, Aminian and colleagues analyzed data from 4,365 patients who tested positive for COVID-19 between March 8 and July 22 in the Cleveland Clinic Health System. Within the COVID-19 cohort, 33 patients underwent prior bariatric surgery.

Researchers propensity-matched patients 1:10 with nonsurgical COVID-19 patients to create a cohort of control patients (n = 330) with a BMI of at least 40 kg/m² at the time of COVID-19 testing. The primary endpoint was the rate of hospital admission. Exploratory endpoints included admission to the ICU, need for mechanical ventilation and dialysis during index hospitalization, and mortality.

The average BMI of the surgical group was 49.1 kg/m2 before bariatric surgery and decreased to a mean of 37.2 kg/m² at the time of COVID-19 testing, compared with the control group’s mean BMI of 46.7 kg/m². The median interval between bariatric surgery and a positive COVID-19 test was 46 months.

In the univariate analysis, six patients in the bariatric surgery group and 139 patients in the control group were admitted to the hospital (18.2% vs. 42.1%; P = .013). In the multivariate analysis, a prior history of bariatric surgery was associated with a lower hospital admission rate compared with control patients with obesity (OR = 0.31; 95% CI, 0.11-0.88).

None of the four exploratory outcomes occurred in the bariatric surgery group; however, in the control group 43 patients (13%) required ICU admission (P = .021), 22 patients (6.7%) required mechanical ventilation, five patients (1.5%) required dialysis and eight patients (2.4%) died.

“This pandemic has been a wake-up call to expose the health consequences of obesity,” Aminian said. “If a person with obesity can lose weight and become healthier, then the risk of having a severe form of COVID-19 will significantly decrease. The take-home message is care of people with obesity should continue during the pandemic, including behavioral changes, medical and surgical management of obesity. Hopefully, these services can continue without interruption, and ... if we can manage obesity, we will have much better outcomes for our patients.”

For more information:

Ali Aminian, MD, can be reached at aminiaa@ccf.org.