30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries
Authors: Singhal Rishi , Ludwig Christian , Rudge Gavin , Gkoutos Georgios V. , Tahrani Abd , Mahawar Kamal ,   on behalf of the GENEVA Collaborators, Pędziwiatr Michał , Major Piotr , Zarzycki Piotr , Pantelis Athanasios , Lapatsanis Dimitris P. , Stravodimos Georgios , Matthys Chris , Focquet Marc , Vleeschouwers Wouter , Spaventa Antonio G , Zerrweck Carlos , Vitiello Antonio , Berardi Giovanna , Musella Mario , Sanchez-Meza Alberto , Cantu Felipe J. , Mora Fernando , Cantu Marco A. , Katakwar Abhishek , Reddy D. Nageshwar , Elmaleh Haitham , Hassan Mohammad , Elghandour Abdelrahman , Elbanna Mohey , Osman Ahmed , Khan Athar , Layani Laurent , Kiran Nalini , Velikorechin Andrey , Solovyeva Maria , Melali Hamid , Shahabi Shahab , Agrawal Ashish , Shrivastava Apoorv , Sharma Ankur , Narwaria Bhavya , Narwaria Mahendra , Raziel Asnat , Sakran Nasser , Susmallian Sergio , Karagöz Levent , Akbaba Murat , Pişkin Salih Zeki , Balta Ahmet Ziya , Senol Zafer , Manno Emilio , Iovino Michele Giuseppe , Osman Ahmed , Qassem Mohamed , Arana-Garza Sebastián , Povoas Heitor P. , Vilas-Boas Marcos Leão , Naumann David , Super Jonathan , Li Alan , Ammori Basil J. , Balamoun Hany , Salman Mohammed , Nasta Amrit Manik , Goel Ramen , Sánchez-Aguilar Hugo , Herrera Miguel F. , Abou-Mrad Adel , Cloix Lucie , Mazzini Guilherme Silva , Kristem Leonardo , Lazaro Andre , Campos Jose , Bernardo Joaquín , González Jesús , Trindade Carlos , Viveiros Octávio , Ribeiro Rui , Goitein David , Hazzan David , Segev Lior , Beck Tamar , Reyes Hernán , Monterrubio Jerónimo , García Paulina , Benois Marine , Kassir Radwan , Contine Alessandro , Elshafei Moustafa , Aktas Sueleyman , Weiner Sylvia , Heidsieck Till , Level Luis , Pinango Silvia , Ortega Patricia Martinez , Moncada Rafael , Valenti Victor , Vlahović Ivan , Boras Zdenko , Liagre Arnaud , Martini Francesco , Juglard Gildas , Motwani Manish , Saggu Sukhvinder Singh , Al Moman Hazem , López Luis Adolfo Aceves , Cortez María Angelina Contreras , Zavala Rodrigo Aceves , D’Haese Christine , Kempeneers Ivo , Himpens Jacques , Lazzati Andrea , Paolino Luca , Bathaei Sarah , Bedirli Abdulkadir , Yavuz Aydın , Büyükkasap Çağrı , Özaydın Safa , Kwiatkowski Andrzej , Bartosiak Katarzyna , Walędziak Maciej , Santonicola Antonella , Angrisani Luigi , Iovino Paola , Palma Rossella , Iossa Angelo , Boru Cristian Eugeniu , De Angelis Francesco , Silecchia Gianfranco , Hussain Abdulzahra , Balchandra Srivinasan , Coltell Izaskun Balciscueta , Pérez Javier Lorenzo , Bohra Ashok , Awan Altaf K , Madhok Brijesh , Leeder Paul C , Awad Sherif , Al-Khyatt Waleed , Shoma Ashraf , Elghadban Hosam , Ghareeb Sameh , Mathews Bryan , Kurian Marina , Larentzakis Andreas , Vrakopoulou Gavriella Zoi , Albanopoulos Konstantinos , Bozdag Ahemt , Lale Azmi , Kirkil Cuneyt , Dincer Mursid , Bashir Ahmad , Haddad Ashraf , Hijleh Leen Abu , Zilberstein Bruno , de Marchi Danilo Dallago , Souza Willy Petrini , Brodén Carl Magnus , Gislason Hjörtur , Shah Kamran , Ambrosi Antonio , Pavone Giovanna , Tartaglia Nicola , Kona S. Lakshmi Kumari , Kalyan K. , Perez Cesar Ernesto Guevara , Botero Miguel Alberto Forero , Covic Adrian , Timofte Daniel , Maxim Madalina , Faraj Dashti , Tseng Larissa , Liem Ronald , Ören Gürdal , Dilektasli Evren , Yalcin Ilker , AlMukhtar Hudhaifa , Al Hadad Mohammed , Mohan Rasmi , Arora Naresh , Bedi Digvijaysingh , Rives-Lange Claire , Chevallier Jean-Marc , Poghosyan Tigran , Sebbag Hugues , Zinaï Lamia , Khaldi Saadi , Mauchien Charles , Mazza Davide , Dinescu Georgiana , Rea Bernardo , Pérez-Galaz Fernando , Zavala Luis , Besa Anais , Curell Anna , Balibrea Jose M. , Vaz Carlos , Galindo Luis , Silva Nelson , Caballero José Luis Estrada , Sebastian Sergio Ortiz , Marchesini João Caetano Dallegrave , da Fonseca Pereira Ricardo Arcanjo , Sobottka Wagner Herbert , Fiolo Felipe Eduardo , Turchi Matias , Coelho Antonio Claudio Jamel , Zacaron Andre Luis , Barbosa André , Quinino Reynaldo , Menaldi Gabriel , Paleari Nicolás , Martinez-Duartez Pedro , de Aragon Ramírez de Esparza Gabriel Martínez , Esteban Valentin Sierra , Torres Antonio , Garcia-Galocha Jose Luis , Josa Miguel , Pacheco-Garcia Jose Manuel , Mayo-Ossorio Maria Angeles , Chowbey Pradeep , Soni Vandana , de Vasconcelos Cunha Hercio Azevedo , Castilho Michel Victor , Ferreira Rafael Meneguzzi Alves , Barreiro Thiago Alvim , Charalabopoulos Alexandros , Sdralis Elias , Davakis Spyridon , Bomans Benoit , Dapri Giovanni , Van Belle Koenraad , Takieddine Mazen , Vaneukem Pol , Karaca Esma Seda Akalın , Karaca Fatih Can , Sumer Aziz , Peksen Caghan , Savas Osman Anil , Chousleb Elias , Elmokayed Fahad , Fakhereldin Islam , Aboshanab Hany Mohamed , Swelium Talal , Gudal Ahmad , Gamloo Lamees , Ugale Ayushka , Ugale Surendra , Boeker Clara , Reetz Christian , Hakami Ibrahim Ali , Mall Julian , Alexandrou Andreas , Baili Efstratia , Bodnar Zsolt , Maleckas Almantas , Gudaityte Rita , Guldogan Cem Emir , Gundogdu Emre , Ozmen Mehmet Mahir , Thakkar Deepti , Dukkipati Nandakishore , Shah Poonam Shashank , Shah Shashank Subhashchandra , Shah Simran Shashank , Adil Md Tanveer , Jambulingam Periyathambi , Mamidanna Ravikrishna , Whitelaw Douglas , Adil Md Tanveer , Jain Vigyan , Veetil Deepa Kizhakke , Wadhawan Randeep , Torres Antonio , Torres Max , Tinoco Tabata , Leclercq Wouter , Romeijn Marleen , van de Pas Kelly , Alkhazraji Ali K. , Taha Safwan A. , Ustun Murat , Yigit Taner , Inam Aatif , Burhanulhaq Muhammad , Pazouki Abdolreza , Eghbali Foolad , Kermansaravi Mohammad , Jazi Amir Hosein Davarpanah , Mahmoudieh Mohsen , Mogharehabed Neda , Tsiotos Gregory , Stamou Konstantinos , Barrera Rodriguez Francisco J. , Rojas Navarro Marco A. , Torres Omar MOhamed , Martinez Sergio Lopez , Tamez Elda Rocio Maltos , Millan Cornejo Gustavo A. , Flores Jose Eduardo Garcia , Mohammed Diya Aldeen , Elfawal Mohamad Hayssam , Shabbir Asim , Guowei Kim , So Jimmy By , Kaplan Elif Tuğçe , Kaplan Mehmet , Kaplan Tuğba , Pham DangTuan , Rana Gurteshwar , Kappus Mojdeh , Gadani Riddish , Kahitan Manish , Pokharel Koshish , Osborne Alan , Pournaras Dimitri , Hewes James , Napolitano Errichetta , Chiappetta Sonja , Bottino Vincenzo , Dorado Evelyn , Schoettler Axel , Gaertner Daniel , Fedtke Katharina , Aguilar-Espinosa Francisco , Aceves-Lozano Saul , Balani Alessandro , Nagliati Carlo , Pennisi Damiano , Rizzi Andrea , Frattini Francesco , Foschi Diego , Benuzzi Laura , Parikh Chirag , Shah Harshil , Pinotti Enrico , Montuori Mauro , Borrelli Vincenzo , Dargent Jerome , Copaescu Catalin A. , Hutopila Ionut , Smeu Bogdan , Witteman Bart , Hazebroek Eric , Deden Laura , Heusschen Laura , Okkema Sietske , Aufenacker Theo , den Hengst Willem , Vening Wouter , van der Burgh Yonta , Ghazal Ahmad , Ibrahim Hamza , Niazi Mourad , Alkhaffaf Bilal , Altarawni Mohammad , Cesana Giovanni Carlo , Anselmino Marco , Uccelli Matteo , Olmi Stefano , Stier Christine , Akmanlar Tahsin , Sonnenberg Thomas , Schieferbein Uwe , Marcolini Alejandro , Awruch Diego , Vicentin Marco , de Souza Bastos Eduardo Lemos , Gregorio Samuel Azenha , Ahuja Anmol , Mittal Tarun , Bolckmans Roel , Wiggins Tom , Baratte Clément , Wisnewsky Judith Aron , Genser Laurent , Chong Lynn , Taylor Lillian , Ward Salena , Chong Lynn , Taylor Lillian , Hi Michael W , Heneghan Helen , Fearon Naomi , Plamper Andreas , Rheinwalt Karl , Heneghan Helen , Geoghegan Justin , Ng Kin Cheung , Fearon Naomi , Kaseja Krzysztof , Kotowski Maciej , Samarkandy Tarig A , Leyva-Alvizo Adolfo , Corzo-Culebro Lourdes , Wang Cunchuan , Yang Wah , Dong Zhiyong , Riera Manel , Jain Rajesh , Hamed Hosam , Said Mohammed , Zarzar Katia , Garcia Manuel , Türkçapar Ahmet Gökhan , Şen Ozan , Baldini Edoardo , Conti Luigi , Wietzycoski Cacio , Lopes Eduardo , Pintar Tadeja , Salobir Jure , Aydin Cengiz , Atici Semra Demirli , Ergin Anıl , Ciyiltepe Huseyin , Bozkurt Mehmet Abdussamet , Kizilkaya Mehmet Celal , Onalan Nezihe Berrin Dodur , Zuber Mariana Nabila Binti Ahmad , Wong Wei Jin , Garcia Amador , Vidal Laura , Beisani Marc , Pasquier Jorge , Vilallonga Ramon , Sharma Sharad , Parmar Chetan , Lee Lyndcie , Sufi Pratik , Sinan Hüseyin , Saydam Mehmet 
Published: July 2021

Abstract
Background
There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates.

Methods
We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020.

Results
Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country.

Conclusions
BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.