Prior bariatric surgery may lower risks for poor COVID-19 outcomes
Adults with type 2 diabetes who previously had bariatric surgery for obesity were less likely to need mechanical ventilation or die after hospitalization for COVID-19 compared with those who did not have surgery, according to study data.
In post hoc analysis from the French multicenter nationwide CORONADO study, adults with a history of bariatric surgery who were hospitalized for COVID-19 in the first month of the pandemic had a significantly lower likelihood for poor outcomes compared with BMI-matched controls who did not undergo surgery. The findings provide an additional reason people with severe obesity may opt for surgery, according to Francois Pattou, MD, PhD, professor of surgery at University Hospital of Lille in France.
“Obesity is a major risk factor for severe COVID-19, but efficiently reducing obesity with surgery reduces the severity of later infection by COVID-19,” Pattou told Healio. “This pandemic and others yet to come are another reason for promoting the active reduction of severe obesity.”
Pattou and colleagues obtained data from 20 adults in the CORONADO study with diabetes who were admitted to a hospital in France for COVID-19 between March 10 and April 10, 2020, and had previously undergone bariatric surgery (60% women; mean age, 59 years). The group was matched 3:1 by sex, age and BMI measured either before surgery or at hospital admission with other people in CORONADO who did not undergo bariatric surgery. The primary outcomes were invasive mechanical ventilation and death at day 7. For those who remained hospitalized at day 7, researchers collected outcomes up to day 28.
The findings were published in Obesity.
Of the 20 participants in the bariatric surgery group, 16 underwent a single procedure, and eight achieved a weight loss of 50% or more. Surgery was performed a median of 8.5 years prior to hospitalization for COVID-19.
At day 7, four people in the bariatric surgery group required invasive mechanical ventilation and one person died. An additional participant died at day 28.
Compared with a control group matched for preoperative BMI, participants who underwent bariatric surgery were less likely to require invasive mechanical ventilation or die of COVID-19 at day 7 (adjusted OR = 0.15; 95% CI, 0.01-0.94; P = .03) and day 28 (aOR = 0.11; 95% CI, 0.01-0.71; P = .02). The researchers noted that the bariatric surgery group included only 16 of 20 participants because four did not have preoperative BMI available.
In secondary analysis matching the bariatric surgery group with controls by admission BMI, there was no difference in rates of mechanical ventilation and death at day 7 and day 28.
The researchers wrote the study had a low number of people who underwent bariatric surgery and had an adverse COVID-19 outcome. Pattou said the findings need to be replicated in a clinical cohort study.
“We need to understand the exact reasons why obesity promotes severe forms and what are the mechanisms responsible for this apparent protective effect of surgical weight loss; if it’s weight loss itself or a more complex biological mechanism,” Pattou said.
For more information:
Francois Pattou, MD, PhD, can be reached at firstname.lastname@example.org.