IMPACT OF BARIATRIC SURGERY ON OUTCOMES OF HOSPITALIZED PATIENTS WITH COVID-19: A NATIONWIDE ANALYSIS
Muhammad Haseeb*1, Maham Waqar2, FNU Faheela3, Umar Hayat4, Pichamol Jirapinyo1, Christopher C. Thompson1
1Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; 2King Edward Medical University, Lahore, Pakistan; 3Nishtar Medical University, Multan, Pakistan; 4Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA
Introduction:
Obesity and several obesity-related co-morbidities are known risk factors for the increased severity of COVID-19. Bariatric surgery (BS) is the most effective treatment for obesity. However, there is a gap in our understanding of whether treatment of obesity with BS will reduce the adverse outcomes of COVID-19. Therefore, our study aimed to evaluate the impact of BS on the severity of COVID-19 in hospitalized patients in the US.
Methods:
National Inpatient Sample (NIS) for 2020 was queried using ICD-10-CM Codes to identify a cohort of inpatient admissions with a primary discharge diagnosis of COVID-19 and a secondary diagnosis of obesity or Bariatric Surgery (BS). A weighted sample was used to get baseline characteristics and resource utilization during the inpatient admissions. Multivariate logistic regression analysis followed by predictive margins was used to obtain adjusted estimates of the utilization of therapeutics (Remdesivir, Tocilizumab, or Convalescent Plasma), mortality, intubation, and Intensive Care Unit (ICU) care.
Results:
Among 36,210 patients admitted with COVID, 280,360 (78.3%) had obesity, and 7850 (21.7%) had prior BS. The mean age was similar in both groups (58.1 years vs. 58.0 years). There was a greater proportion of patients in the BS group who were female, white, and had private insurance compared to those with obesity without BS. In adjusted analysis, the BS group experienced decreased intubation (7.4% vs. 12.4%), ICU Care (7.6% vs. 12.6%), utilization of therapeutics (34.3% vs. 38.2%), and Mortality (6.3% vs. 9.8) which were all statistically significant. Length of stay and total hospital charges were higher for the obesity group compared to BS. A lesser number of patients in the obesity group were discharged home than those with BS (62.1% vs. 67.8%, p-value <0.01).
Discussion: Our study found that patients admitted with COVID-19 with a history of prior BS had better in-hospital outcomes and decreased severity of COVID-19 compared with patients with obesity and no history of BS. These findings confirm the urgency for proper care in this underserved population and demands better access to the full spectrum of effective weight loss therapies.
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