Bariatric surgery linked to lower risk of hospitalization and intensive care

Reviewed by Emily Henderson, B.Sc.November 24, 2020

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

In recent months, researchers around the world have identified obesity as a risk factor for developing severe COVID-19, which may require hospitalization, the need for intensive care, and the use of support. ventilatory.

The Centers for Disease Control and Prevention reported that more than 70 percent of U.S. adults are overweight or have obesity, which can increase the risk of serious coronavirus disease.

Obesity is a complex disease caused by multiple factors that weaken the immune system. Obesity creates a chronic inflammatory state that causes an excessive production of cytokines, small proteins involved in the immune response.

Coronavirus infection also triggers the immune system to release cytokines, which can lead to excessive production of organ-damaging cytokines. This may partly explain the severity of the infection in patients with obesity. “

Ali Aminian, MD, Studio Pprincipal investigator e Director of the Bariatric & Metabolic Institute, Cleveland Clinic

Additionally, obesity increases the risk of cardiovascular disease, hypertension, diabetes, kidney disease, and blood clot formation. These conditions can lead to poor results after an infection with SARS-CoV-2, which is the virus that causes COVID-19.

Obesity can also affect the respiratory system. Many patients with obesity have underlying lung conditions, such as sleep apnea and hypoventilation syndrome of obesity, which can worsen the outcomes of COVID-19 pneumonia.

“Dr. Aminian’s study provides further evidence of the important link between obesity and poor coronavirus infection outcomes. The study shows for the first time that substantial weight loss through bariatric surgery can actually reduce the risk of severe disease in these patients, “says co-author Steven Nissen, MD, Chief Academic Officer of the Heart, Vascular and Thoracic Institute at Cleveland Clinic.

Looking at 4,365 patients who tested positive for SARS-CoV-2 between March 8, 2020 and July 22, 2020, the researchers identified 33 patients who had a previous history of weight loss surgery (20 patients had a sleeve gastrectomy). and 13 patients had a Roux-en-Y gastric bypass).

The 33 surgical patients were carefully matched 1:10 to non-surgical patients with obesity to assemble a cohort of 330 control patients with a BMI of 40 or higher at the time of the SARS-CoV-2 test.

This matched cohort study of 363 patients showed that sustained weight loss and improvement in diabetes and hypertension in the bariatric surgical group prior to contracting COVID-19 were associated with a much lower rate of hospitalization and ICU admissions. .

Eighteen percent of patients in the weight loss surgery group and 42% of patients in the control group required hospitalization after contracting COVID-19. Additionally, 13% of patients in the control group required intensive care admission, 7% required mechanical ventilation, and 2.4% died. None of these occurred in the surgical group.

“Patients after bariatric surgery become significantly healthier and can fight the virus better,” adds Dr. Aminian. “If confirmed by future studies, this can be added to the long list of health benefits of bariatric surgery such as improvement in diabetes, hypertension, fatty liver disease, sleep apnea, and prevention of heart attack, stroke, kidney disease and death.”

Another study from the Cleveland Clinic showed that weight loss surgery was associated with a 40% reduction in the risk of death and heart complications in patients with diabetes and obesity.