Background

Background: Prior studies have shown bariatric surgery to be safe during the COVID-19 pandemic. However, studies examining outcomes in infected patients are fewer. This is the first large database analysis of COVID-19’s impact on bariatric surgery outcomes. Objectives: Evaluate impact of COVID-19 infection on bariatric surgery outcomes. Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) centers.

Methods

Propensity-matched analysis of MBSAQIP 2021 data. Cohorts including pre-operative COVID+ and post-operative COVID+ patients were matched to healthy controls and 30-day post-operative outcomes analyzed.

Results

166,230 patients undergoing sleeve gastrectomy (70%) or Roux-en-Y gastric bypass (30%) met study criteria, with 1,303 pre-operative COVID+ patients and 1,104 post-operative COVID+ patients. Following propensity matching by demographics and comorbidities, 1276 pre-operative COVID+ were compared to negative controls, and 1096 post-operative COVID+ patients compared to negative patients. Pre-operative COVID infection had similar outcomes for anastomotic leak, venous thromboembolism or other complications compared to matched controls. However, compared to matched controls, patients with 30-day post-operative COVID infection had significantly more anastomotic leaks (1.3% vs 0.2%, p<0.01), venous thrombosis (0.8% vs 0.1%, p<0.05), pneumonia (2.8% vs 0.2%, p<0.001), ICU admission (1.5% vs 0.5%, p<0.05), reoperation (2.3% vs 0.9%, p<0.05), readmission (14.4% vs 3.5%, p<0.001), Emergency Department visits (29.2% vs 9.4%, p<0.001), and outpatient IV hydration (9.2% vs 4.0%, p<0.001).

Conclusions

COVID-19 infection within 30 days after bariatric surgery is associated with adverse outcomes including anastomotic leaks, while preoperative infection did not impact outcomes. Greater attention to continued preoperative testing and enforcement of vaccination should be considered.