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GENEVA: 30-day outcomes after surgery during COVID-19 pandemic

Tue, 12/01/2020 - 09:05
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Thirty-day morbidity and mortality outcomes after bariatric and metabolic surgery (BMS) during the COVID-19 pandemic are comparable to pre-pandemic levels, according to the findings from the Global 30-day outcomes after bariatric surgery during the COVID-19 pandemic (GENEVA) study. The findings reported in the paper, ‘Global 30-day outcomes after bariatric surgery during the COVID-19 pandemic (GENEVA), an international cohort study’, were published in The Lancet Diabetes and Endocrinology by UK researchers, on behalf of the GENEVA study collaborators.

The authors noted that despite the development of guidelines of how to safely manage BMS during the COVID pandemic, there was a lack of data on the 30-day morbidity and mortality outcomes. Therefore, they establish an international study to record and analyse the outcomes from surgery between 1 May and 10 July 2020.

The study recruited 2,001 patients from 218 surgeons at 127 hospitals in 35 countries (all patients had 30-day morbidity and mortality data recorded). A majority of patients had a sleeve gastrectomy (n=1142 [57%]), followed by a Roux-en-Y gastric bypass (n=557 [28%]), one-anastomosis gastric bypass (n=215 [11%]) and 87 patients (4%) had a different procedure.

The authors reported one death during the 30-day post-operative period resulting in a mortality rate of 0.05% (n=1/2001), the patient was COVID-19 negative. The mortality rate, the authors stated, is consistent with the pre-pandemic figures reported in the literature (0.04–0.1%). The reported complication rate at 30 days was 6.8% (138 complications in 137 patients), which is also similar to previously published studies the authors noted.

The majority of complications (n=83 [60·6%]) reported were mild (Clavien-Dindo grade I and II) and were identified in patients were more likely to be older and current/ex-smokers. Most complications occurred in patients who had a sleeve gastrectomy (n=65, 47.4%). Fewer complications (n=8, 5.8%) occurred with more experienced surgeons who had performed more than 5,000 procedures.

Ten patients were diagnosed with symptomatic COVID-19 during the 30-day follow-up (0.5%), eight patients from countries (Brazil, Egypt and Mexico) that had their COVID-19 peak during the study period. None of the ten patients required ventilation. The authors caution that the low rates of patients diagnosed with symptomatic COVID-19 during the study period could be due to variable timing of COVID-19 peak (in relation to the study period). Therefore, local heterogeneity in COVID-19 prevalence could have contributed to the small number of symptomatic COVID-19 in the study. They believe this was reflective of the presence and efficacy of local perioperative COVID-19 protocols.

“In conclusion, our study showed that 30-day morbidity and mortality following BMS during the COVID-19 pandemic with locally appropriate perioperative COVID-19 protocols in place seemed to be similar to pre-pandemic levels,” the wrote. “However, with the evolving pandemic situation, BMS teams need to continually monitor outcome data.”

This study was funded by the research funds of the bariatric unit at University Hospitals Birmingham NHS Foundation Trust (Birmingham, UK).

To access this paper, please click here