History of Bariatric Surgery Improves COVID-19 Outcomes in Patients with Obesity

Bertrand Cariou

Obesity is shown to increase the risk of severe forms of COVID-19, making obesity management a priority in order to reduce the severity of the virus.

Due to this, a post-hoc analysis was performed on patient data from the CORONADO (Coronavirus SARS-CoV2 and Diabetes Outcomes) regarding history of metabolic and bariatric surgery (MBS) in patients with type 2 diabetes and severe obesity who were hospitalized for COVID-19.

The team of investigators, led by Bertrand Cariou, Department of Endocrinology, Diabetology and Nutrition, l’institut du Thorax, observed a previous history of MBS in obese patients with T2D and hospitalized for COVID-19 might have associations with a better prognosis in comparison to those without MBS.

Methods

The CORONADO study was a retrospective study designed to describe phenotypic characteristics and prognosis of patients with diabetes admitted for COVID-19 to 68 French hospitals. It occurred between March - April 2020.

Investigators included any patient with personal history of MBS in the exposed group and matched them 3:1 with other CORONADO patients without a history of MBS. They were matched according to sex, age (± 3 years) and body mass index (±3 kg/m2) measured before surgery or at the time of hospital admission. The control group was matched using BMI on admission.

Composite primary outcomes were considered a combination of invasive mechanical ventilation (IMV) and/or death by day 7. Then, a secondary time point was considered by day 28 for all patients alive and not discharged by day 7.

What were the findings?

Out of a total of 2398 patients with type 2 diabetes in CORONADO, 20 (0.83%) had a previous history of MBS, at a median of 8.5 years before admission to the hospital.

This patient population with a history of MBS consisted of mostly female patients (60%) with a mean age of 59.0 ± 10.8 years.

Data show at day 7, a total of 5 out of 20 patients with MBS (25%) experienced the primary composite outcome. Investigators noted that these outcomes were mainly invasive mechanical ventilation (n = 4), rather than death (n = 1).

As a result, data show the rate of CPO was not statistically different between patients with or without MBS by day 7 (25.0% versus 28.7%; OR, 0.83, 0.30 - 2.29, P = .72) or day 28 (25.0% versus 35.4%; OR, 0.61, 0.22 - 1.68, P = .34).

Then, when the team matched BMI at the time of MBS following adjustment on diabetes duration, they found the primary outcome occurred less frequently within 7 days (3 versus 17 events, OR: 0.15, 0.01 - 0.94, P = .03).

It remained the same within 28 days (3 versus 19 events, OR: 0.11, 0.01 - 0.71, P = .02) in patients with MBS (n = 16) versus control (n = 44).

What did they say?

“Prospective studies are needed to confirm these results in larger populations in order to further promote efficient weight loss interventions as therapeutic strategy to improve COVID-19 prognosis in patients with severe obesity,” investigators wrote.

The study, “History of bariatric surgery and COVID 19 outcomes in patients with type 2 diabetes: results from the CORONADO study,” was published in Obesity: A Research Journal.