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December 7, 2020

Should You Consider Having A Bariatric Surgery During the COVID-19 Pandemic?

A Cleveland Clinic study shows that among obese patients who tested positive for COVID-19, previous bariatric surgery was significantly associated with a lower risk of hospitalization and admission to an intensive care unit. The results are published in the journal Surgery for Obesity and Related Diseases.

In recent months, researchers around the world have identified obesity as a risk factor for the development of severe COVID-19, which may require hospitalization, intensive care, and the use of mechanical ventilation. The Centers for Disease Control and Prevention has reported that over 70% of the US adult population is overweight or obese, which could increase the risk of severe coronavirus disease.

Bariatric surgery (weight loss surgery) has long been recognized as an effective treatment for helping overweight patients better manage their weight. And recent news of the positive effects of weight loss surgery on diabetes has sparked even more interest in the NuHealth Bariatric Surgery Unit at the University of Nassau Medical Center. As a nationally recognized Center of Excellence for Bariatric Surgery, the department is well placed to help patients achieve their weight loss goals and improve overall health.

Obesity is a complicated sickness caused by many factors that break the immune system. Obesity creates a chronic inflammatory condition that causes an overproduction of cytokines, which are small proteins involved in the immune response.

“Coronavirus infection also causes the immune system to release cytokines, which can lead to over-production of cytokines that damages organs. This may partially explain the severity of the infection in obese patients ”says Ali Aminian, MD, director of the Bariatric & Metabolic Institute of Cleveland Clinic and principal investigator of the study.

In addition, obesity increases the risk of heart disease, hypertension, diabetes, kidney disease, and blood clots. These conditions can lead to poor results after being infected with SARS-CoV-2, the virus that causes COVID-19. Obesity can also affect the respiratory system. Many obese patients have comorbid lung conditions, such as sleep apnea and obesity hypoventilation syndrome, which can worsen the outcome of COVID-19 pneumonia.

“Dr. Aminian's study provides additional evidence for an important link between obesity and adverse outcomes from coronavirus infection. The study shows for the first time that significant weight loss through bariatric surgery can actually reduce the risk of severe illness in these patients, ”says co-author Stephen Nissen, MD, chief research officer at the Heart, Vascular and Chest Institute, Cleveland Hospital.

After studying 4365 patients who tested positive for SARS-CoV-2 between March 8, 2020 and July 22, 2020, the researchers identified 33 patients who had a history of weight loss surgery (20 patients underwent gastric sleeve surgery and 13 patients underwent weight loss surgery). Roux-en-Y gastric anastomosis). 33 surgical patients were carefully matched 1:10 with non-surgical obese patients to assemble a cohort of 330 control patients with a body mass index of 40 or higher at the time of SARS-CoV-2 testing.

This consistent cohort study of 363 patients found that sustained weight loss and improved diabetes and hypertension rates in the bariatric surgery group prior to COVID-19 infection were associated with much lower hospital admissions and admissions.

18% of patients in the bariatric surgery group and 42% of patients in the check-up group requesting hospitalization after contracting COVID-19. In addition, 13% of patients in need to the ICU, 7% required mechanical ventilation and 2.4% died. 

Patients with bariatric surgery are significantly healthier and can better fight the virus,” adds Dr. Aminian. "If confirmed by future research, it could add to the long list of health benefits of bariatric surgery, such as improving diabetes, hypertension, fatty liver, sleep apnea, and preventing heart attack, stroke, kidney disease and death."

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