key: cord-0779683-rcyop5il authors: Hany, Mohamed; Torensma, Bart title: Incidence and presentation of COVID-19 in the vaccinated and unvaccinated patients undergoing bariatric surgery date: 2022-05-06 journal: Obesity Pillars DOI: 10.1016/j.obpill.2022.100019 sha: b9fcbde64f386a4561a8bf551fc1cc7785fb2b53 doc_id: 779683 cord_uid: rcyop5il Background This study aimed to describe the incidence and clinical presentation of fully vaccinated and unvaccinated patients who tested positive for COVID-19 in the first year after Madina Women’s Hospital in Alexandria, Egypt, resumed bariatric surgery procedures. (The clinic was closed between March 2020 and reopened in mid-October 2020) Methods This prospective cohort study was conducted between November 2020 till the end of December 2021. We identified patients undergoing bariatric surgery infected with COVID-19 with and without vaccination. COVID-19 severity was assessed based on the Egypt Ministry of Health guidelines. Some patients were isolated at home, whereas others were hospitalised. Results During the one year after the restart of bariatric surgery procedures, 606 patients underwent bariatric procedures (n = 280 fully vaccinated, n = 320 unvaccinated). During follow-up, that period, the incidence of COVID-19 in the vaccinated group was 1.07% (n = 3) versus 14.1% (n = 46) in the unvaccinated group. Three patients had mild symptoms in the vaccinated group, and no hospital admission was necessary. In the unvaccinated group, 27 patients (60%) were classified as mild, eight (17.8%) as moderate, eight (17.8%) as moderate with risk, and two (4.4%) as severe; the mortality rate was 0%. Of these, 16 (88.9%) were hospitalised, of which six (33.3%) were admitted to the intensive care unit in the moderate to severe groups. Conclusion Patients with obesity are at increased risk for COVID-19 infection and adverse consequences. Our findings showed a higher incidence of COVID-19 among those unvaccinated versus vaccinated. Therefore, at least during times and locations of a COVID-19 pandemic, vaccinations may be beneficial for patients against COVID-19 prior to bariatric surgery. Exclusion criteria included the inability to give informed consent. Patients with comorbidities 98 were not excluded from undergoing the operation; however, patients with surgical complications were 99 excluded from this analysis. The patients were contacted 48 h after discharge, and outpatient visits were set up at a weekly 113 interval for 1 month by a team of nurses to check and record the measured temperatures. Patients were 114 also provided with a hotline to call physicians and report any of the previously mentioned symptoms as 115 soon as possible. Patients with hypertension and diabetes were monitored closely. Patients who reported any symptoms were requested to visit the hospital for a clinical 117 assessment and laboratory tests that included PCR testing and chest and abdomen computed 118 tomography (CT) imaging. Patients with a positive PCR test without any surgical complications were 119 included in the study and followed up for at least 2 months after recovery. were asked to isolate at home with symptomatic management and monitoring of oxygen saturation 127 (SpO2) and pulse rate using a pulse oximeter. Regarding patients with moderate symptoms, the patients 128 with positive imaging scans and SpO2 ≥ 92% were also asked to isolate at home and monitor themselves. In those with moderate with risk factors symptoms, risk factors such as high age > 60 years, SpO2 < 130 92%, heart rate > 110 bpm, respiratory rate > 25 /min, uncontrolled comorbidities, and BMI > 40 kg/m 2 , 131 admitted to a COVID-19 hospital for oxygen mask therapy. Patients with severe symptoms (i.e. Incidence and presentation of COVID-19 in vaccinated and unvaccinated patients undergoing bariatric surgery Incidence of COVID-19 in vaccinated and unvaccinated patients undergoing bariatric surgery. The following criteria were used to decide when to end home isolation: 1) At least 10 days had The COVID-19 incidence in this study of unvaccinated (14.1%) patients is high. The group of 246 vaccinated patients (1.07%) shows that it is possible to significantly decrease the number of incidences 247 and, therefore, create a safer window for operating postoperative care. Nevertheless, even with this fact 248 of high incidence, the mortality was 0%, and all patients recovered in the infected unvaccinated group; 249 we can therefore suggest that bariatric surgery can be seen as safe in pandemic times if enough 250 precautionary measures are taken before, during, and after surgery, even when vaccination is not always 251 available for everybody in the society. In addition, the expected behavior of humans must be considered 252 a natural part of the increased incidence, even with the imposition of restrictions and precautions, and 253 the effect of vaccination. We saw that the expected behavior (for example, visiting family and friends) 254 during the postoperative period was happening. When they got interviewed about the signs and 255 symptoms, the research nurses were told how difficult it was to abide by the rules. In the same period 256 when the vaccination rate was low, it is plausible that vaccination was also not present among friends 257 and family at that time. Therefore, a possible spreader-effect within that group could also happen. After 258 a period of quarantine, the everyday life of this group was also resumed. Therefore, it is also logical 259 that the basis for this is that more infections with COVID-19 would occur, and the incidence would rise. It is important to note that although patients were asked to self-isolate as recommended by the IFSO This study also had some limitations. Firstly, because we cannot conclude with certainty that 287 all infected patients were included in this study, we could not accurately determine the infection rate 288 since some patients could also witness an infection without symptoms and therefore did not contact us. Secondly, the study was a descriptive statistics study with a relatively small group of patients. Excellent and extensive inferential and prognostic analyses were not possible since there were too few 291 variables and low incidence in the vaccinated group to test for and correct the data; therefore, correcting 292 for bias was impossible. Third, we did not distinguish outcomes for different bariatric procedures since 293 this would decrease the power of the study vs the low incidence but can be relevant in new studies. serological testing. This may have interfered in the results and the effect on the incidence ratio between 296 vaccinated and unvaccinated patients, as well as the ability of the body to activate antibodies faster and 297 improve pre-operative immunity. Patients with obesity are at increased risk for COVID-19 infection and adverse consequences. Our 300 findings showed a higher incidence of COVID-19 among those unvaccinated versus vaccinated. 301 Therefore, at least during times and locations of a COVID-19 pandemic, vaccinations may be beneficial 302 for patients against COVID-19 prior to bariatric surgery. Also, appropriate precautionary measures, 303 approaches, and guidelines for the patient before, during, and after surgery with a multi-disciplinary 304 team could prove beneficial effects in all groups. Future studies are necessary to investigate the long-305 term impact of COVID-19 and the vaccine that may be required before surgery. Gastroesophageal reflux disease 10 (21.7) - Sleeve gastrectomy 28 (60.9) 2 (66.6%) One anastomosis gastric bypass 10 (21.7) -Roux-en-Y gastric bypass 6 (13.1) 1 (33. Steroids, retinoids, and wound healing COVID-19 and obesity-the 337 management of pre-and post-bariatric patients amidst the COVID-19 pandemic COVID-19 Vaccination and Bariatric Surgery Coronavirus Pandemic (COVID-19 Ahram Online. 1,141 Egyptian receive COVID-19 shot on the first day of vaccine roll out for 353 priority groups Egypt: Al-Ahram Establishment Discovering statistics using IBM SPSS Statistics Survey of the current status of subclinical coronavirus 358 disease 2019 (COVID-19) Outcomes of patients with obesityhospitalized with 360 COVID-19: the impact of prior bariatric surgery Obesity and mortality in critically ill COVID-19 patients 362 with respiratory failure J o u r n a l P r e -p r o o f