Top

Published in:

01-11-2020 | Obesity | Review

COVID-19: IFSO LAC Recommendations for the Resumption of Elective Bariatric Surgery

Authors: Estuardo Behrens, Luis Poggi, Sergio Aparicio, Pedro Martínez Duartez, Nelson Rodríguez, Natan Zundel, Almino Ramos Cardoso, Diego Camacho, Juan Antonio López-Corvalá, Marcos Leão Vilas-Bôas, Jorge Laynez

Published in: Obesity Surgery | Issue 11/2020

Abstract

Background

COVID-19 pandemic varies greatly and has different dynamics in every country, city, and hospital in Latin America. Obesity increases the risk of SARS-CoV-2 infection, and it is one of the independent risk factors for the most severe cases of COVID-19. Currently, the most effective treatment against obesity available is bariatric and metabolic surgery (BMS), which further resolves or improves other independent risk factors like diabetes and hypertension.

Objective

Provide recommendations for the resumption of elective BMS during COVID-19 pandemic.

Method

This document was created by the IFSO-LAC Executive Board and a task force. Based on data collected from a survey distributed to all IFSO-LAC members that obtained 540 responses, current evidence available, and consensus reached by other scientific societies.

Results

The resumption of elective BMS must be a priority maybe similar to oncological surgery, when hospitals reach phase I or II, treating obesity patients in a NON-COVID area, avoiding inadvertent intrahospital contagion from healthcare provider, patients, and relatives. Same BMS indication and types of procedures as before the pandemic. Discard the presence of SARS-CoV-2 within 72 h prior to surgery. Continues laparoscopic approach. The entire team use N95 mask. Minimum hospital stays. Implement remote visits for the follow-up.

Conclusion

Resumption of elective BMS is crucial because it is not only a weight loss operation but also resolves or improves comorbidities and appears to be an immune restorative procedure of obese patients in the medium term, offering them the same probability of contracting COVID-19 as the regular population.

Available only for authorised users

Guan WY, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–20.CrossRef

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506.CrossRef

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054.CrossRef

Ministry of Health, Italy. Coronavirus disease (COVID-19) situation report in Italy. Rome: Ministry of Health, Italy. [Accessed Jun 2020]. Available from: http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus.jsp?lingua=italiano&id=5351&area=nuovoCoronavirus&menu=vuoto

Ministerio de Sanidad, Consumo y Bienestar Social. [Internet]. España; c2019. [Accessed Jun 2020]. Disponible en: https://covid19.isciii.es. Royal Decree 463/2020, of March 14, which decrees the state of alarm for the management of health crisis caused by COVID-19.

Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323:1239.CrossRef

Ruan Q, Yang K, Wang W, et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;

Coccolini F, Tartaglia D, Puglisi A, et al. SARS CoV2 is present in peritoneal fluid in COVID 19 patients. Ann Surg. 2020;

10.

https://www.who.int/features/factfiles/obesity/en/ [Accessed May 2020]

11.

Global BMI Mortality Collaboration, Di Angelantonio E, Bhupathiraju SHN, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388(10046):776–86.CrossRef

12.

Warkentin LM, Majumdar SR, Johson JA, et al. Predictors of health-related quality of life in 500 severely obese patients. Obesity (Silver Spring). 2014;22(5):1367–72. https://doi.org/10.1002/oby.20694.CrossRef

13.

Flegal KM, Kit BK, Orpana H, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309(1):71–82. https://doi.org/10.1001/jama.2012.113905.CrossRefPubMedPubMedCentral

14.

Padwal RS, Pajewski NM, Allison DB, et al. Using the Edmonton obesity staging system to predict mortality in a population- representative cohort of people with overweight and obesity. CMAJ. 2011;183(14):E1059–66. https://doi.org/10.1503/cmaj.110387.CrossRefPubMedPubMedCentral

15.

Whitlock G, Lewington S, et al. Prospective studies collaboration. Body-mass index and cause-specific mortality in 900.000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96. https://doi.org/10.1016/S0140-6736(09)60318-4.CrossRefPubMed

16.

Simonnet A, Chetboun M, Poissy J, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation [published online ahead of print, 2020 Apr 9]. Obesity (Silver Spring). 2020; https://doi.org/10.1002/oby.22831.

17.

Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission [published online ahead of print, 2020 Apr 9]. Clin Infect Dis. 2020;ciaa415 https://doi.org/10.1093/cid/ciaa415.

18.

Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020:2052. https://doi.org/10.1001/jama.2020.6775.

19.

Kass DA, Duggal P, Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. Lancet. 2020; https://doi.org/10.1016/S0140-6736(20)31024-2.

20.

Qingxian C, Chen F, Fang L, et al. Obesity and COVID-19 severity in a designated hospital in Shenzhen, China. 2020; https://doi.org/10.2139/ssrn.3556658.

21.

Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City. medRxiv. https://doi.org/10.1101/2020.04.08.20057794.

22.

Luzi L, Radaelli MG. Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic. Acta Diabetol. 2020;57(6):759–64. https://doi.org/10.1007/s00592-020-01522-8.CrossRefPubMed

23.

Groups at higher risk for severe illness. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html. [Accessed May 2020]

24.

Hanipah ZN, Schauer PR. Surgical treatment of obesity and diabetes. Gastrointest Endosc Clin N Am. 2017;27(2):191–211. https://doi.org/10.1016/j.giec.2016.12.005.CrossRefPubMed

25.

Kim J, Eisenberg D, Azagury D, et al. ASMBS position statement on long-term survival benefit after metabolic and bariatric surgery. Surg Obes Relat Dis. 2016;12(3):453–9. https://doi.org/10.1016/j.soard.2015.11.021.CrossRefPubMed

26.

Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861–77. https://doi.org/10.2337/dc16-0236.CrossRefPubMed

27.

De Luca M, Angrisani L, Himpens J, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2016;26(8):1659–96. https://doi.org/10.1007/s11695-016-2271-4.CrossRefPubMedPubMedCentral

28.

Ackermann M, Alva O, Alvarez MG, et al. Consenso de cirugía metabólica en Argentina (Consensus of Metabolic Surgery in Argentina). Rev Soc Arg de Diabetes. 2015;49(3):95–110.CrossRef

29.

Ricci C, Gaeta M, Rausa E, et al. Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: a meta-analysis and meta-regression study with 5-year follow-up. Obes Surg. 2015;25(3):397–405.CrossRef

30.

Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87.CrossRef

31.

Puzziferri N, Roshek TB, Mayo HG, et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014;312(9):934–42.CrossRef

32.

Busetto L, Dixon J, De Luca M, et al. Bariatric surgery in class I obesity: a position statement from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2014;24(4):487–519. https://doi.org/10.1007/s11695-014-1214-1.CrossRefPubMed

33.

Neff KJ, le Roux CW. Bariatric surgery: the indications in metabolic disease. Dig Surg. 2014;31(1):6–12. https://doi.org/10.1159/000351440.CrossRefPubMed

34.

Casimiro Pérez JA, Fernández Quesada C, Del Val Groba Marco M, et al. Obesity surgery score (OSS) for prioritization in the bariatric surgery waiting list: a need of public health systems and a literature review. Obes Surg. 2018;28(4):1175–84. https://doi.org/10.1007/s11695-017-3107-6.CrossRefPubMed

35.

Arteaga-González IJ, Martín-Malagón AI, Ruiz de Adana JC, et al. Bariatric surgery waiting lists in Spain. Obes Surg. 2018;28(12):3992–6. https://doi.org/10.1007/s11695-018-3453-z.CrossRefPubMed

36.

Cohen RV, Luque A, Junqueira S, et al. What is the impact on the healthcare system if access to bariatric surgery is delayed? Surg Obes Relat Dis. 2017;13(9):1619–27. https://doi.org/10.1016/j.soard.2017.03.025.CrossRefPubMed

37.

Flanagan E, Ghaderi I, Overby DW, et al. Reduced survival in bariatric surgery candidates delayed or denied by lack of insurance approval. Am Surg. 2016;82(2):166–70.CrossRef

38.

Lakoff JM, Ellsmere J, Ransom T. Cause of death in patients awaiting bariatric surgery. Can J Surg. 2015;58(1):15–8. https://doi.org/10.1503/cjs.002914.CrossRefPubMedPubMedCentral

39.

Al Harakeh AB, Burkhamer KJ, Kallies KJ, et al. Natural history and metabolic consequences of morbid obesity for patients denied coverage for bariatric surgery. Surg Obes Relat Dis. 2010;6(6):591–6.CrossRef

40.

Cottam DR, Schaefer PA, Shaftan GW, et al. Effect of surgically-induced weight loss on leukocyte indicators of chronic inflammation in morbid obesity. Obes Surg. 2002;12(3):335–42. https://doi.org/10.1381/096089202321088101.CrossRefPubMed

41.

Moulin CM, Rizzo LV, Halpern A. Effect of surgery-induced weight loss on immune function. Expert Rev Gastroenterol Hepatol. 2008;2(5):617–9. https://doi.org/10.1586/17474124.2.5.617.CrossRefPubMed

42.

Prachand VN, Milner R, Angelos P, et al. Medically necessary, time-sensitive procedures: scoring system to ethically and efficiently manage resource scarcity and provider risk during the COVID-19 pandemic [published online ahead of print, 2020 Apr 9]. J Am Coll Surg. 2020;S1072–7515(20):30317–3. https://doi.org/10.1016/j.jamcollsurg.2020.04.011.CrossRef

43.

Lei S, Jiang F, Su W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection [published online ahead of print, 2020 Apr 5]. EClinicalMedicine. 2020:100331. https://doi.org/10.1016/j.eclinm.2020.100331.

44.

Tuech JJ, Gangloff A, Di Fiore F, et al. Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic [published online ahead of print, 2020 Mar 31]. J Visc Surg. 2020;S1878–7886(20):30070–9. https://doi.org/10.1016/j.jviscsurg.2020.03.008.CrossRef

45.

Forrester JD, Nassar AK, Maggio PM, et al. Precautions for operating room team members during the COVID-19 pandemic [published online ahead of print, 2020 Apr 2]. J Am Coll Surg. 2020;S1072–7515(20):30303. https://doi.org/10.1016/j.jamcollsurg.2020.03.030.CrossRef

46.

Joint Statement Roadmap for Resuming Elective Surgery after COVID-19 Pandemic 41720update por American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, American Hospital Association. https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/joint-statement-on-elective-surgery-after-covid-19-pandemic [Accessed May 2020]

47.

Recomendaciones de la Asociación Española de Cirugía (Recommendations of the Spanish Association of Surgery). https://www.aecirujanos.es/Documentos-de-posicionamiento-y-recomendaciones-de-la-AEC-en-relacion-con-la-cirugia-y-COVID19_es_1_152.html [Accessed May 2020]

48.

Recomendaciones del Colegio Americano de Cirugía (Recommendations of the American College of Surgeons - ACS). https://www.facs.org/covid-19 [Accessed May 2020]

49.

Recomendaciones de la Sociedad Americana de cirujanos gastrointestinales y endoscopistas (Recommendations of the Society of American Gastrointestinal and Endoscopic Surgeons). https://www.sages.org/category/covid-19/ [Accessed May 2020]

50.

Surgical services protocol from Hospital Universitario Virgen del Rocio de Sevilla (Spain) and surgical services from Hospital de Pavia (Italy). https://www.hospitaluvrocio.es/entrada-blog/protocolos-c-general-covid-19/ [Accessed May 2020]

51.

Surgical care protocol during the COVID-19 pandemic. QUIRON SALUD (Spain), updated April 16, 2020 [Accessed May 2020]

52.

Recomendaciones de la Sociedad Americana de Cirugía Bariatrica y Metabólica https://asmbs.org/resources/covid-19-resource-center [Accessed May 2020]

53.

Rubino F, Cohen R, Mingrone, et al. Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery. Lancet Diabetes Endocrinol. 2020; https://doi.org/10.1016/S2213-8587(20)30157-1.

Title: COVID-19: IFSO LAC Recommendations for the Resumption of Elective Bariatric Surgery
Authors: Estuardo Behrens
Luis Poggi
Sergio Aparicio
Pedro Martínez Duartez
Nelson Rodríguez
Natan Zundel
Almino Ramos Cardoso
Diego Camacho
Juan Antonio López-Corvalá
Marcos Leão Vilas-Bôas
Jorge Laynez
Publication date: 01-11-2020
Publisher: Springer US
Keywords: Obesity
Obesity
Bariatric Surgery
Bariatric Surgery
SARS-CoV-2
COVID-19
Published in: Obesity Surgery / Issue 11/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-020-04910-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

COVID-19: IFSO LAC Recommendations for the Resumption of Elective Bariatric Surgery

Abstract

Background

Objective

Method

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2020

Correction to: The Procedureless Elipse Gastric Balloon Program: Multicenter Experience in 1770 Consecutive Patients

5-Year Results of Banded One-Anastomosis Gastric Bypass: a Pilot Study in Super-Obese Patients

The Effect of Fasting during Ramadan on Outcomes after Bariatric Surgery at an Academic Medical Center in the Middle East

Improving Access to Bariatric Surgery for Rural and Remote Patients: Experiences from a State-Wide Bariatric Telehealth Service in Australia

Submucosal Tunnel Endoscopic Resection of Gastric Lesion Before Obesity Surgery: a Case Series

Gastric Occlusion due to the Intragastric Balloon Displacement in the Era of Coronavirus Disease-19 (COVID-19) Pandemic, Operative Management: a Case Report