Modeling the Impact of Delaying Bariatric Surgery due to COVID-19: a Decision Analysis

doi:10.1007/s11695-020-05054-6

. 2021 Mar;31(3):1387-1391.

doi: 10.1007/s11695-020-05054-6. Epub 2020 Oct 26.

Modeling the Impact of Delaying Bariatric Surgery due to COVID-19: a Decision Analysis

Maren E Shipe¹, Alicia Beeghly-Fadiel², Stephen A Deppen^{3

4}, Wayne English¹, Eric L Grogan^{5

6}

Affiliations

¹ Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
² Department of Medicine and Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA.
³ Department of Thoracic Surgery, Vanderbilt University Medical Center, 609 Oxford House, 1313 21st Ave. South, Nashville, TN, 37232, USA. steve.deppen@vumc.org.
⁴ Department of Thoracic Surgery, Tennessee Valley Healthcare System, Nashville, TN, USA. steve.deppen@vumc.org.
⁵ Department of Thoracic Surgery, Vanderbilt University Medical Center, 609 Oxford House, 1313 21st Ave. South, Nashville, TN, 37232, USA.
⁶ Department of Thoracic Surgery, Tennessee Valley Healthcare System, Nashville, TN, USA.

PMID: 33104988
PMCID: PMC7587518
DOI: 10.1007/s11695-020-05054-6

Modeling the Impact of Delaying Bariatric Surgery due to COVID-19: a Decision Analysis

Maren E Shipe et al. Obes Surg. 2021 Mar.

. 2021 Mar;31(3):1387-1391.

doi: 10.1007/s11695-020-05054-6. Epub 2020 Oct 26.

Authors

Maren E Shipe¹, Alicia Beeghly-Fadiel², Stephen A Deppen^{3

4}, Wayne English¹, Eric L Grogan^{5

6}

Affiliations

¹ Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
² Department of Medicine and Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA.
³ Department of Thoracic Surgery, Vanderbilt University Medical Center, 609 Oxford House, 1313 21st Ave. South, Nashville, TN, 37232, USA. steve.deppen@vumc.org.
⁴ Department of Thoracic Surgery, Tennessee Valley Healthcare System, Nashville, TN, USA. steve.deppen@vumc.org.
⁵ Department of Thoracic Surgery, Vanderbilt University Medical Center, 609 Oxford House, 1313 21st Ave. South, Nashville, TN, 37232, USA.
⁶ Department of Thoracic Surgery, Tennessee Valley Healthcare System, Nashville, TN, USA.

PMID: 33104988
PMCID: PMC7587518
DOI: 10.1007/s11695-020-05054-6

Abstract

We developed a decision analysis model to evaluate risks and benefits of delaying scheduled bariatric surgery during the novel coronavirus disease (COVID-19) pandemic. Our base case was a 45-year-old female with diabetes and a body mass index of 45 kg/m². We compared immediate with delayed surgery after 6 months to allow for COVID-19 prevalence to decrease. We found that immediate and delayed bariatric surgeries after 6 months resulted in similar 20-year overall survival. When the probability of COVID-19 infection exceeded 4%, then delayed surgery improved survival. If future COVID-19 infection rates were at least half those in the immediate scenario, then immediate surgery was favored and local infection rates had to exceed 9% before surgical delay improved survival. Surgeons should consider local disease prevalence and patient comorbidities associated with increased mortality before resuming bariatric surgery programs.

Keywords: Bariatric surgery; COVID-19; Coronavirus; Decision analysis; Risk modeling; Sleeve gastrectomy.

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Figures

**Fig. 1**
a Decision analysis tree for resuming bariatric surgery during COVID-19 pandemic. Blue square: decision node, whether to choose immediate or delayed surgery. Green circles: chance nodes. Red triangles: terminal nodes. b Two-way sensitivity analysis for probability of infection and mortality from COVID-19. Graph displays the favored strategy (immediate or delayed surgery) across a range of possible hospital-acquired COVID-19 infection and COVID-19-related mortality probabilities while holding all other model variables constant at baseline values

See this image and copyright information in PMC

Cited by

Surgical Infection Society Guidance for Restoration of Surgical Services during the Coronavirus Disease-2019 Pandemic.
Barie PS, Ho VP, Hunter CJ, Kaufman EJ, Narayan M, Pieracci FM, Schubl SD, Heffernan DS, Huston JM. Barie PS, et al. Surg Infect (Larchmt). 2021 Oct;22(8):818-827. doi: 10.1089/sur.2020.421. Epub 2021 Feb 25. Surg Infect (Larchmt). 2021. PMID: 33635145 Free PMC article.

References

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1. Cohen RV, Luque A, Junqueira S, Ribeiro RA, Le Roux CW. What is the impact on the healthcare system if access to bariatric surgery is delayed? Surg Obes Relat Dis. 2017;13(9):1619–1627. doi: 10.1016/j.soard.2017.03.025. - DOI - PubMed
1. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020 [cited 2020 May 3]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32320003. - PMC - PubMed
1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA J Am Med Assoc. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed
1. Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, Prill M, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Yousey-Hindes K, Niccolai L, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan P, Henderson J, Kim S, Como-Sabetti K, Lynfield R, Sosin D, Torres S, Muse A, Bennett NM, Billing L, Sutton M, West N, Schaffner W, Talbot HK, Aquino C, George A, Budd A, Brammer L, Langley G, Hall AJ, Fry A. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 — COVID-NET, 14 states, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458–464. doi: 10.15585/mmwr.mm6915e3. - DOI - PMC - PubMed

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[1] Flanagan E, Ghaderi I, Overby D, Farrell T. Reduced survival in bariatric surgery candidates delayed or denied by lack of insurance approval. Am Surg. 2016;82(2):166–170. doi: 10.1177/000313481608200222. - DOI - PubMed

[2] Flanagan E, Ghaderi I, Overby D, Farrell T. Reduced survival in bariatric surgery candidates delayed or denied by lack of insurance approval. Am Surg. 2016;82(2):166–170. doi: 10.1177/000313481608200222. - DOI - PubMed

[3] Cohen RV, Luque A, Junqueira S, Ribeiro RA, Le Roux CW. What is the impact on the healthcare system if access to bariatric surgery is delayed? Surg Obes Relat Dis. 2017;13(9):1619–1627. doi: 10.1016/j.soard.2017.03.025. - DOI - PubMed

[4] Cohen RV, Luque A, Junqueira S, Ribeiro RA, Le Roux CW. What is the impact on the healthcare system if access to bariatric surgery is delayed? Surg Obes Relat Dis. 2017;13(9):1619–1627. doi: 10.1016/j.soard.2017.03.025. - DOI - PubMed

[5] Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020 [cited 2020 May 3]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32320003. - PMC - PubMed

[6] Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020 [cited 2020 May 3]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32320003. - PMC - PubMed

[7] Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA J Am Med Assoc. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed

[8] Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA J Am Med Assoc. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed

[9] Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, Prill M, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Yousey-Hindes K, Niccolai L, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan P, Henderson J, Kim S, Como-Sabetti K, Lynfield R, Sosin D, Torres S, Muse A, Bennett NM, Billing L, Sutton M, West N, Schaffner W, Talbot HK, Aquino C, George A, Budd A, Brammer L, Langley G, Hall AJ, Fry A. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 — COVID-NET, 14 states, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458–464. doi: 10.15585/mmwr.mm6915e3. - DOI - PMC - PubMed

[10] Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, Prill M, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Yousey-Hindes K, Niccolai L, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan P, Henderson J, Kim S, Como-Sabetti K, Lynfield R, Sosin D, Torres S, Muse A, Bennett NM, Billing L, Sutton M, West N, Schaffner W, Talbot HK, Aquino C, George A, Budd A, Brammer L, Langley G, Hall AJ, Fry A. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 — COVID-NET, 14 states, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458–464. doi: 10.15585/mmwr.mm6915e3. - DOI - PMC - PubMed

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Modeling the Impact of Delaying Bariatric Surgery due to COVID-19: a Decision Analysis

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Modeling the Impact of Delaying Bariatric Surgery due to COVID-19: a Decision Analysis

Authors

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Abstract

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