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SHIFTING TRENDS OF PATIENT OUTCOMES IN ELECTIVE BARIATRIC SURGERY PRE- AND POST-COVID 19
Daniel Guifarro
*2, Clive J. Miranda
1, Bhanu Siva Mohan Pinnam
2, Alexander Carlson
3, Nariman Hossein-Javaheri
3, Aun R. Shah
11Gastroenterology, Creighton University, Omaha, NE; 2John H Stroger Jr Hospital of Cook County, Chicago, IL; 3University at Buffalo, Buffalo, NY
The obesity epidemic is one of the most significant public health challenges in the United States, with over 42% of adults currently classified as obese. This crisis has driven the demand for bariatric surgery (BS) for sustainable weight loss and obesity-related comorbidities. However, the recent COVID-19 pandemic disrupted healthcare systems nationwide, resulting in widespread delays and cancellations of elective surgeries, including BS. The repercussions not only created backlogs but also influenced patient outcomes due to deferred care and the unique health risks associated with COVID-19 in obese populations. Our study examines the trend in patient outcomes for elective BS, comparing pre-pandemic and post-pandemic periods.
We performed a retrospective cohort study using the National Inpatient Sample (NIS) from 2018 to 2021, focusing on adult patients admitted for elective BS during the pre-COVID-19 years (2018–2019) and post-COVID-19 years (2020–2021). Both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures were categorized under a single variable (BS). The study evaluated same-admission complications following the procedure, with a comparative analysis of outcomes between pre- and post-COVID-19 periods. Statistical methods included measures of central tendency, T-tests, and linear and logistic regression. Statistical significance was defined as p <0.05, with risks quantified using odds ratios (OR). Confounding variables such as age, gender, hospital characteristics, Charlson Comorbidity Index, and insurance status were adjusted for using STATA 18.
A total of 382,180 patients pre-COVID (2018-2019) and 356,750 patients post-COVID (2020-2021) were analyzed. Demographic breakdowns are shown in Figure 1 as well as proportions of patients in each cohort who underwent RYGB and SG procedures. The mortality rate of patients admitted for BS pre-COVID was 0.72% compared to 0.26% post-COVID, and this reduction was statistically significant. Weekend admissions had a significantly higher mortality rate than weekday admissions in both pre- and post-COVID periods. For every increase in age by 1 year, the odds of mortality increased by 9% in both pre- and post-COVID periods for RYGB and BS. Females had significantly decreased odds of death for BS pre- and post-COVID. Specifically, females undergoing SG had 92% decreased odds of mortality post-COVID. The odds of having a blood transfusion for RYGB pre-COVID was reduced by 57% compared to a 66% reduction during post-COVID. All these findings are shown in Figure 2.
Discrepancies exist among both the offering of bariatric surgery and resulting patient outcomes when comparing pre-COVID and post-COVID periods. These timestamps should serve as an impetus for further investigative efforts in healthcare systems to optimize clinical care.
Sociodemographic data of patients admitted for elective bariatric surgery.
Outcomes of patients undergoing elective bariatric surgery.
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