Surgical Tribune Europe

Delaying bariatric and metabolic surgery during COVID-19 pandemic puts patients at risk

By King's College London
May 14, 2020

LONDON, UK: Bariatric and metabolic surgery, used to treat Type 2 diabetes and obesity, has been suspended during the COVID-19 pandemic in order to free up inpatient capacity and reduce the risks of infection among patients and staff. However, in a recent paper, experts from the Diabetes Surgery Summit (DSS), an international consensus conference series, have warned that the backlog of operations could increase risks of morbidity and mortality for patients awaiting surgery.

Social distancing policies and lockdown might limit adherence to lifestyle interventions such as healthy diet and physical exercise, which can worsen the health of affected patients. Compared with non-surgical treatments, bariatric and metabolic surgery leads to greater long-term weight loss, reduction of cardiovascular risk, remission of diabetes and can improve survival.

Severe obesity, diabetes and hypertension can increase the risk for severe COVID-19 complications and bariatric or metabolic surgery can dramatically and rapidly improve these conditions. Delaying surgery may therefore leave many patients vulnerable to severe consequences of a SARS-CoV-2 infection.

“The misconception that bariatric surgery is a ‘last resort’, [...] can penalise candidates for surgical treatment of obesity and diabetes”

— Prof. Francesco Rubino, King’s College London

Prof. Paul Zimmet, from Monash University in Melbourne in Australia, Honorary President of the International Diabetes Federation and co-author of the paper, said: “These operations are called elective because they can be scheduled in advance not because the treatment they provide is less necessary. Metabolic surgery is a potentially lifesaving treatment for selected obese persons with Type 2 diabetes.”

The DSS experts recommend that patients should have access to surgical treatment within 90 days for the following indicators:

  • being at substantial risk of complications of diabetes such as cardiovascular disease or renal failure,
  • Type 2 diabetes requiring insulin,
  • poor control of blood sugar levels despite taking multiple medications,
  • severe forms of obesity (BMI over 60) or less severe obesity if there are at least three co-morbidities including liver, respiratory, renal or cardiac disease,
  • need weight loss or metabolic improvement for other time sensitive treatments such as organ transplants,
  • standard access to bariatric and metabolic surgery can be reserved for patients who are unlikely to deteriorate within 6 months, but these patients need to be optimised using intensive medical treatment to maintain optimal control.

They also recommend mandatory COVID-19 screening pre-operatively for all patients considering metabolic surgery. Despite the theoretical higher risk of contagion for staff, the study found laparoscopic surgery remains the best approach, but appropriate personal protective equipment should be used.

Lead author Prof. Francesco Rubino, chair of bariatric and metabolic surgery at King’s College London and a consultant surgeon at King’s College Hospital, said: “In times of limited resources, patients with greatest risk of harm from untreated disease should be identified and prioritised for timely-access to the treatment they need. The misconception that bariatric surgery is a ‘last resort’, widespread stigma of obesity and inadequate criteria for patients’ selection can penalise candidates for surgical treatment of obesity and diabetes.”

The paper, titled “Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery”, was published online on 7 May 2020 in The Lancet Diabetes and Endocrinology.

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