Prior Bariatric Surgery in COVID-19 Positive Patients May Be Protective

Introduction Patients infected with novel COVID-19 virus have a spectrum of illnesses ranging from asymptomatic to death. Data has shown that age, gender and obesity are strongly correlated with poor outcomes in COVID-19 positive patients. Bariatric surgery is the only treatment that provides significant, sustained weight loss in the severely obese. We look at whether prior bariatric surgery correlates with increased risk of hospitalization and outcome severity after COVID-19 infection. Methods A cross-sectional retrospective analysis of a COVID-19 database from a single, NYC-based, academic institution was conducted. A cohort of COVID-19 positive patients with a history of bariatric surgery (n=124) were matched in a 4:1 ratio to a control cohort of COVID-19 positive patients who were eligible for bariatric surgery (BMI ≥40 kg/m 2 or BMI ≥35 kg/m 2 with a comorbidity) (n=496). A comparison of outcomes, including mechanical ventilation requirements and deceased at discharge, was done between cohorts using Chi-square test or Fisher’s exact test. Additionally, overall length of stay and duration of time in ICU were compared using Wilcoxon Rank Sum test. Conditional logistic regression analyses were done to determine both unadjusted (UOR) and adjusted odds ratios (AOR). Results A total of 620 COVID-19 positive patients were included in this analysis. The categorization of bariatric surgeries included 36% Roux-en-Y Gastric Bypass (RYGB, n=45), 35% laparoscopic adjustable gastric banding (LAGB, n=44), and 28% laparoscopic sleeve gastrectomy (LSG, n=35). The body mass index (BMI) for the bariatric group was 36.1 kg/m 2 (SD=8.3), which was significantly lower than the control group, 41.4 kg/m 2 (SD=6.5) (p<0.0001). There was also less burden of diabetes in the bariatric group (32%) compared to the control group (48%) (p=0.0019). Patients with a history of bariatric surgery were less likely to be admitted through the emergency room (UOR=0.39, p=0.0001), less likely to have had a ventilator used during the admission (UOR=0.42, p=0.028), had a shorter length of stay in both the ICU (p=0.033) and overall (UOR=0.44, p=0.0002), and were less likely to be deceased at discharge compared to the control group (OR=0.42, p=0.028). Conclusion A history of bariatric surgery significantly decreases the risk of emergency room admission, mechanical ventilation, prolonged ICU stay, and death in patients with COVID-19.