Is There a Role for ERAS Program Implementation to Restart Bariatric Surgery After the Peak of COVID-19 Pandemic?
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LETTER TO THE EDITOR
Is There a Role for ERAS Program Implementation to Restart Bariatric Surgery After the Peak of COVID-19 Pandemic? Giovanni Fantola 1 & Carlo Nagliati 2
&
Mirto Foletto 3 & Alessandro Balani 2 & Roberto Moroni 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
The ongoing pandemic from coronavirus disease 2019 (COVID-19) has suddenly and deeply changed the daily practice in surgical departments all around the world [1]. Several surgical societies hurriedly prepared recommendations [2–6], the need to reduce, postpone, or cancel all elective surgical cases or endoscopic invasive procedures being the common shared starting point. A negative prognostic link of obesity as a risk factor for a severe disease in case of SARS-COV-2 infection has already been suggested [7, 8], and further studies seem to confirm an elevated body mass index (BMI) as the first preventable risk factor [9, 10], just following advanced age. A BMI > 35 kg/m2 would increase about seven times the risk of switching to mechanical ventilation compared to BMI < 25 kg/m2 [9]. In Italy, accordingly to other affected countries, bariatric surgery (BS) was promptly and diffusely stopped. The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) gave us a general recommandation [11]: “All elective surgical and endoscopic cases for metabolic and bariatric surgery should be postponed during the pandemic. This minimises risks to both patient and healthcare team, as well as reducing the utilisation of unnecessary resources, such as beds, ventilators and personal protective equipment. In addition, postponing these services will minimise potential exposure of the COVID-19 virus to unsuspecting healthcare providers and patients”. Giovanni Fantola and Carlo Nagliati contributed equally to this work. * Carlo Nagliati [email protected] 1
Department of Surgery, Obesity Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
2
Department of Surgery, San Giovanni di Dio Hospital, Gorizia, Italy
3
Week Surgery, Bariatric Unit, University of Padova, Padua, Italy
Obesity represents an epidemic public health issue [12–14]. Sixteen million people with obesity are living in Italy and 15,000 of them underwent BS in 2019 [15], that represents the most effective treatment at the moment [12]. COVID-19 pandemic showed the intrinsic frailty of those patients affected by obesity and metabolic syndrome, while obesity “per se” is considered a risk factor for infection, need ICU admission, and death [16, 17]. Therefore, we could speculate that it should be mandatory to treat obesity as best and early as we can in order to contribute fighting the COVID-19 pandemic. We still do not know what will happen after COVID19 peak, but it is reasonable to envision a slow and progressive restart of elective surgical activity during the second pandemic phase, when the risk of infection could remain still quite high but acceptable. In order to properly manage this resumption, every bariatric surgeon should ask her/himself two qu
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