Weight loss surgery, also known as bariatric and metabolic surgery, is known to be an effective intervention for the treatment of obesity associated progressive, life threatening diseases including type 2 diabetes, heart disease, hypertension, and several respiratory illnesses. Obesity and the associated diseases listed above are all known risk factors for worse outcome for those who develop COVID-19.
During the COVID-19 pandemic, 'elective' surgery has been postponed or cancelled at least in part due to worse outcomes in patients who develop COVID-19 in the early post operative period (30 days post op). There has been a gradual return to providing surgical care, with a tiered system of return with truly 'elective' procedures being the last to be resumed. So, is bariatric and metabolic surgery 'elective'?
In a statement released by the American Society for Metabolic and Bariatric Surgery (ASMBS) the answer is clearly 'no':
For those who define “elective” surgery as not necessary or optional, the American Society for Metabolic and Bariatric Surgery (ASMBS) asserts that metabolic and bariatric surgery is NOT elective. Metabolic and bariatric surgery is medically necessary and the best treatment for those with the life-threatening and life-limiting disease of severe obesity.
The definition of elective in the Merriam-Webster dictionary is “relating to, being, or involving a nonemergency medical procedure and especially surgery that is planned in advance and is not essential to the survival of the patient.” Metabolic and bariatric surgery is life-saving surgery, with multiple studies confirming the survival benefit for patients treated by surgery over those treated without surgery [1 ]. Metabolic and bariatric surgery creates long-term changes in metabolism and reduces or eliminates multiple serious obesity-related diseases improving long-term health and quality of life as well as survival. The ASMBS supports the use of the term “medically necessary time-sensitive surgery,” as proposed by Prachand et al. [2 ], or “medically necessary nonemergent surgery,” as far superior to the term “elective” surgery and what it connotes.
Metabolic and bariatric surgery should be restarted when it is safe to do so. The ASMBS disagrees with the concept that bariatric surgery should be postponed until the pandemic is declared over.
The global nature of the pandemic, the potential for a second wave or persistent ongoing infection in some parts of the world, along with more traditional risks, such as annual influenza outbreaks, make postponement potentially indefinite. There is clear evidence bariatric surgery improves survival [1 ] and significantly improves the disease of obesity and several critical obesity-related conditions (including diabetes, hypertension, and cardiovascular events). Obesity and obesity-related diseases have been identified as independent risk factors for adverse outcomes in COVID-19 infection [3 ], including need for intubation, ventilatory support, intensive care unit care, and mortality. From a patient-centered and public health standpoint, it is critical to resume metabolic and bariatric surgery.
We also understand that obesity and related diseases are the same risk factors that must be taken into consideration for temporarily postponing bariatric surgery in certain higher risk subsets of patients. The risks and benefits at that particular time for that specific patient need to be carefully considered. Factors to consider in making that decision also include the local prevalence of COVID-19, the availability of testing, the available resources, including hospital beds, ventilators and personal protection equipment, as well as strategies to protect healthcare workers and patients. However, delay in the life-saving surgical treatment of obesity and its complications for many months or years is not in the best interest of our patients.
The ASMBS has advocated for many years that patients suffering from the disease of obesity and its many serious associated diseases should strongly consider metabolic and bariatric surgery as a life-changing intervention that improves health, quality of life, and long-term survival. COVID-19 is the most recent of many diseases in which underlying obesity worsens the prognosis.
Before COVID-19 began, it was clear that patients with obesity were “safer through surgery.” In the era of COVID-19, “safer through surgery” for patients with obesity may prove to be even more important than before.
Medically necessary, time sensitive surgery. Delaying not only worsens the outcome of patients who suffer from obesity and end up with COVID-19 in the future, it also worsens the outcome of time sensitive, progessive diseases if not treated in a timely manner.