Bariatric surgery provision in response to the COVID-19 pandemic: retrospective cohort study of a national registry

Abstract

Background When surgery resumed following outbreak of the COVID-19 pandemic, guidelines recommended the prioritization of patients with greater obesity-related comorbidity and/or higher Body Mass Index (BMI). Objectives The aim of this study was to record the effect of the pandemic on total number, patient demographic and peri-operative outcomes of elective bariatric surgery in the United Kingdom. Setting and Method The United Kingdom National Bariatric Surgical Registry was used to identify patients that underwent elective bariatric surgery during the pandemic (one year from 1st April 2020). Characteristics of this group were compared with a pre-pandemic cohort. Primary outcomes were case volume, case-mix and provider. National Health Service (NHS) cases were analyzed for baseline health status and peri-operative outcomes. Chi-square, Fisher’s exact or Student’s t-test were used as appropriate. Results Total number of cases reduced to one third of pre-pandemic volume (8615 to 2930). Operating volume reduction varied, with thirty-six (45%) hospitals experiencing a 75-100% reduction. Cases performed in the NHS fell from 74% to 53% (p<0.0001). There was no change in baseline BMI (45.2 kg/m2 ± 8.3 from 45.5 kg/m2 ± 8.3; p=0.228) or prevalence of Type 2 Diabetes Mellitus (26% from 26%; p=0.999. Length of stay (median 2 days) and surgical complication rate (1.4% from 2.0%; RR 0.71 (95% CI 0.45 – 1.12); p=0.133) were unchanged. Conclusions In the context of a dramatic reduction in elective bariatric surgery due to the COVID-19 pandemic, patients with more severe comorbidity were not prioritized for surgery. These findings should inform preparation for future crises.