Impact of Preoperative COVID-19 on Postoperative Outcomes in Patients Undergoing Bariatric/Metabolic Surgery: an Updated Analysis of TrinetX Databases.
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Abstract
Background: The impact of preoperative coronavirus disease (COVID-19) on outcomes after metabolic and bariatric surgery (MBS) remains incompletely understood, as previous studies were conducted early in the pandemic, when viral strains and management differed.
Methods: Using the TriNetX database, we conducted a retrospective analysis of patients who underwent MBS between June 2022 and December 2024. Patients with COVID-19 within 4 weeks before surgery were propensity-score matched 1:1 with controls without prior COVID-19 based on demographics, obesity-associated medical condition, and laboratory values. The primary outcome was the incidence of postoperative pulmonary complications (i.e., pneumonia or acute respiratory failure), while the secondary outcomes included the incidence of acute kidney injury (AKI), intensive care unit (ICU) admission, other infections (i.e., surgical site infection or urinary tract infection), mortality, and emergency department (ED) visits.
Results: Among 34,652 matched patients, 30-day pulmonary complications showed no significant difference between the COVID-19 and control groups (odds ratio[OR]: 0.898, 95%CI:0.674-1.197, p = 0.4646). However, the COVID-19 group experienced higher rates of AKI (OR:1.407, 95%CI:1.087-1.823, p = 0.0093) and ED visits (OR:1.169, 95%CI:1.082-1.264, p < 0.0001). Other secondary outcomes were similar between the groups. COPD, anemia, and old age were significant risk factors for pulmonary complications. Risk factors for AKI include chronic kidney disease, male sex, anemia, diabetes mellitus, and cardiovascular diseases.
Conclusion: Recent preoperative COVID-19 was not associated with increased risk of pulmonary complications following MBS, suggesting surgery need not be delayed for this concern. However, enhanced monitoring of renal complications and post-discharge care may be warranted in patients with identified risk factors.
背景：术前冠状病毒病（COVID-19）对代谢和减肥手术（MBS）后结局的影响仍不完全清楚，因为之前的研究是在大流行早期进行的，当时病毒株和管理不同。方法：使用TriNetX数据库，我们对2022年6月至2024年12月期间接受MBS治疗的患者进行了回顾性分析。根据人口统计学、肥胖相关的医疗状况和实验室值，术前4周内感染COVID-19的患者与既往未感染COVID-19的对照组倾向评分1:1匹配。主要结局是术后肺部并发症（即肺炎或急性呼吸衰竭）的发生率，次要结局包括急性肾损伤（AKI）的发生率、重症监护病房（ICU）入院率、其他感染（即手术部位感染或尿路感染）、死亡率和急诊科（ED）就诊率。结果：34,652例匹配患者中，新冠肺炎组与对照组30天肺部并发症发生率无显著差异（优势比[OR]: 0.898, 95%CI:0.674-1.197, p = 0.4646）。然而，COVID-19组的AKI发生率（OR:1.407, 95%CI:1.087-1.823, p = 0.0093）和ED就诊率（OR:1.169, 95%CI:1.082-1.264, p < 0.0001）更高。其他次要结果在两组之间相似。COPD、贫血和老年是肺部并发症的重要危险因素。AKI的危险因素包括慢性肾脏疾病、男性、贫血、糖尿病和心血管疾病。结论：最近的术前COVID-19与MBS后肺部并发症的风险增加无关，提示无需为此延迟手术。然而，对于确定有危险因素的患者，可能需要加强对肾脏并发症的监测和出院后护理。
期刊介绍：
Obesity Surgery is the official journal of the International Federation for the Surgery of Obesity and metabolic disorders (IFSO). A journal for bariatric/metabolic surgeons, Obesity Surgery provides an international, interdisciplinary forum for communicating the latest research, surgical and laparoscopic techniques, for treatment of massive obesity and metabolic disorders. Topics covered include original research, clinical reports, current status, guidelines, historical notes, invited commentaries, letters to the editor, medicolegal issues, meeting abstracts, modern surgery/technical innovations, new concepts, reviews, scholarly presentations and opinions.
Obesity Surgery benefits surgeons performing obesity/metabolic surgery, general surgeons and surgical residents, endoscopists, anesthetists, support staff, nurses, dietitians, psychiatrists, psychologists, plastic surgeons, internists including endocrinologists and diabetologists, nutritional scientists, and those dealing with eating disorders.
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