BARIATRIC SURGERY OUTCOMES AND VOLUMES DURING THE EARLY COVID 19 PANDEMIC
Paul T. Kröner*2, Donghyun Ko3, Do Han Kim3, Pedro Palacios Argueta3, Christopher C. Thompson1
1Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; 2Riverside Healthcare System, Newport News, VA; 3Mayo Clinic in Florida, Jacksonville, FL
Introduction
The early and swift spread of COVID-19 not only significantly impacted access to healthcare for elective, subacute and acute medical conditions across the US, but also resulted in associated worse outcomes in patients with COVID-19 undergoing procedures compared to pre-pandemic estimates. Additionally, hospital understaffing resulted in increased rates of staff burnout, near misses, and other adverse outcomes. The aim of this study was to explore the use and outcomes of inpatients undergoing Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in the early months of the COVID-19 pandemic.
Methods
A retrospective observational study was conducted using the National Inpatient Sample for 2020. All patients with RYGB and SG ICD-10 codes were included. The primary outcome was the monthly inpatient odds of RYGB and SG compared to pre-pandemic Jan. Secondary outcomes were monthly inpatient odds of mortality, morbidity and resource utilization comparing these groups. The month of Jan (pre-pandemic) was used as the comparator month for all outcomes. Multivariate regression was used to adjust for gender, age, insurance status, Charlson Comorbidity Index, income in patient zip code, hospital region, location, size and teaching status.
Results
A total of 173,505 patients who underwent bariatric surgery were identified, of which 62,840 (36.22%) were RYGB. Mean age was 45.1 and 79.3% were female. For the primary outcome, there were significantly lower odds of both RYGB and SG in the months of Mar, Apr and May compared to pre-pandemic Jan. This reflects a dramatic drop in monthly procedures from Jan vs Apr of 5,295 to 1,050 (RYGB) and of 9,600 to 275 (SG). Odds for both procedures were significantly increased in the following months from Jun to Dec when compared to Jan. The odds of inpatient mortality for RYGB were not significantly different throughout the year, while they were significantly higher in the month of Apr for SG (N=10 mortalities for April). Increased odds of morbidity and healthcare utilization measures were also evident in both procedures for the month of Apr compared to Jan (pre-pandemic). All results are displayed in Table 1 and 2.
Conclusion
Performance of bariatric surgical procedures in the US was significantly negatively impacted by the COVID-19 pandemic, particularly in the months of March, April and May. Not only did the procedural volumes "recover" in the following months, but a seemingly "compensatory increase" was seen, as reflected by increased procedural volumes from June-December as compared to January (pre-pandemic). Despite the dramatically lower procedural volumes for the month of April, increased odds of post-procedural morbidity measures were noted for patients undergoing both RYGB and SG in that month. This could be due to several reasons, including staffing, patient acuity, and altered work flows.
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