Outcomes of Obese Patients Hospitalized with COVID-19: The Impact of Prior Bariatric Surgery

Purdy, Amanda C.; Hohmann, Samuel F.; Nguyen, Ninh T.

BACKGROUND: Obesity and several obesity-related comorbidities are risk factors for severe COVID-19 disease. Because bariatric surgery successfully treats obesity-related conditions, we hypothesized that prior bariatric surgery may be associated with less severe COVID-19 disease. OBJECTIVES: To examine the association between prior bariatric surgery and outcomes in patients with obesity admitted with COVID-19 SETTING: United States METHODS: Vizient database was used to obtain demographic and outcomes data for adults with obesity admitted with COVID-19 from May 2020-January 2021. Patients were divided into two groups: those with and those without prior bariatric surgery. The primary outcome was in-hospital mortality. Secondary outcomes were mortality by age, sex, race/ethnicity, and comorbidity, intubation rate, hemodialysis rate, and length of stay (LOS). As the database only provides aggregate data, and not patient-level data, multivariate analysis could not be performed. RESULTS: Among the 124,699 patients with obesity admitted with COVID-19, 2,607 had previous bariatric surgery and 122,092 did not. The proportion of patients >65-years-old was higher in the non-bariatric surgery group (36.0% vs. 27.6%, p<0.0001). Compared to patients without prior bariatric surgery, patients with prior bariatric surgery had lower in-hospital mortality (7.8 vs. 11.2%, p<0.0001) and intubation rates (18.5% vs. 23.6%, p=0.0009). Hemodialysis rate (7.2% vs. 6.9%, p=0.5) and LOS (8.8 vs. 9.6 days, p=0.8) were similar between groups. Mortality was significantly lower in the bariatric surgery group for patients 18-64-years-old (5.9% vs. 7.4%, p=0.01) and >65-years-old (12.9% vs. 17.9%, p=0.0006). CONCLUSIONS: This retrospective cohort study found that inpatients with obesity and COVID-19 who had prior bariatric surgery had improved outcomes compared to a similar cohort without prior bariatric surgery. Further studies should examine mechanisms for the association between bariatric surgery and less severe COVID-19.