Bariatric Surgical Practice During the Initial Phase of COVID-19 Outbreak
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Bariatric Surgical Practice During the Initial Phase of COVID-19 Outbreak Ali Aminian 1 & Mohammad Kermansaravi 2 & Shahriar Azizi 3 & Peyman Alibeigi 4 & Sina Safamanesh 5 & Ali Mousavimaleki 2 & Mohammad Taghi Rezaei 4 & Maziar Faridi 5 & Somayeh Mokhber 2 & Abdolreza Pazouki 2 & Saeed Safari 6
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract There is no data on patients with severe obesity who developed coronavirus disease 2019 (COVID-19) after bariatric surgery. Four gastric bypass operations, performed in a 2-week period between Feb 24 and March 4, 2020, in Tehran, Iran, were complicated with COVID-19. The mean age and body mass index were 46 ± 12 years and 49 ± 3 kg/m2. Patients developed their symptoms (fever, cough, dyspnea, and fatigue) 1, 2, 4, and 14 days after surgery. One patient had unnoticed anosmia 2 days before surgery. Three patients were readmitted in hospital. All 4 patients were treated with hydroxychloroquine. In two patients who required admission in intensive care unit, other off-label therapies including antiretroviral and immunosuppressive agents were also administered. All patients survived. In conclusion, COVID-19 can complicate the postoperative course of patients after bariatric surgery. Correct diagnosis and management in the postoperative setting would be challenging. Timing of infection after surgery in our series would raise the possibility of hospital transmission of COVID-19: from asymptomatic patients at the time of bariatric surgery to the healthcare workers versus acquiring the COVID-19 infection by non-infected patients in the perioperative period. Keywords Bariatric surgery . Gastric bypass . Complications . COVID-19 . Coronavirus . Pneumonia
Introduction The rising pandemic of novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a worldwide crisis for global health and economy. Although the infection has been reported * Ali Aminian [email protected] 1
Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk M61, Cleveland, OH 44195, USA
2
Minimally Invasive Surgery Research Center, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
3
Erfan Niayesh Hospital, Tehran, Iran
4
Mehrad Hospital, Tehran, Iran
5
Iranmehr Hospital, Tehran, Iran
6
Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
all around the world in the first few months of the year 2020, the clinical presentation and outcomes of surgical patients during the COVID-19 outbreak have not been clearly characterized [1]. In response to this progressive global health crisis, following the advice by the governmental and professional authorities [2, 3], bariatric surgical practice, which is an elective surgical procedure, has been temporarily stopped in many places around the world. Based on the current knowledge, the median incubation period of COVID-19 is 4 days (interquartile range, 2 to 7).
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