Abstract
PurposeTo determine the risk of invasive mechanical ventilation and death in obese individuals with a history of bariatric surgery (BS) admitted for COVID-19.MethodsAll obese inpatients recorded during a hospital stay by the French National Health Insurance were included, and their electronic health data were reviewed retrospectively. Patients who had undergone bariatric surgery comprised the BS group and patients with obesity but no history of BS served as controls. The primary outcome was COVID-19-related death and the secondary outcome was the need for invasive mechanical ventilation.Results4,248,253 obese individuals aged 15–75 years were included and followed for a mean observation time of 5.43 ± 2.93 years. 8286 individuals with a previous diagnosis of obesity were admitted for COVID-19 between January 1 and May 15, 2020. Of these patients, 541 had a history of BS and 7745 did not. The need for invasive mechanical ventilation and death occurred in 7% and 3.5% of the BS group versus 15% and 14.2% of the control group, respectively. In logistic regression, the risk of invasive mechanical ventilation was independently associated with increasing age, male sex, and hypertension, and mortality was independently associated with increasing age, male sex, history of heart failure, cancer, and diabetes, whereas BS had an independent protective effect. Two random exact matching tests confirmed the protective effect of BS.ConclusionThis nationwide study showed that BS is independently associated with a reduced risk of death and invasive mechanical ventilation in obese individuals with COVID-19.
Highlights
Obesity, hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and malignancy have all been reported to be associated with a severe clinical course or even mortality in COVID-19
The Lille Intensive Care COVID-19 and Obesity study group reported a sevenfold increase in the risk of mechanical ventilation in individuals with a body mass index (BMI) > 35 kg/m2 admitted with COVID-19 compared with those with a BMI < 25 [4]
With a diagnosis of obesity recorded during a hospital stay between 2010 and 2019, were followed up for a mean (SD) of 5.22 years (± 2.93) for the non-bariatric surgery (BS) group and 5.43 years (± 2.45) for the BS group
Summary
Hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and malignancy have all been reported to be associated with a severe clinical course or even mortality in COVID-19. Before the pandemic, these cardiometabolic diseases already represented a substantial burden worldwide but they are even more of a challenge. Obese individuals have a decreased expiratory reserve volume, a decreased functional capacity, and a lower total respiratory system compliance. In these patients, the respiratory function is diminished in the supine position [7]. Obesity drives an increased risk of chronic diseases that are associated with a severe outcome in COVID-19 [11,12,13]
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