Risk for Severe COVID-19 Decreases After Surgical Intervention for Weight Loss

Significant weight loss after surgical intervention was associated with improved outcomes from COVID-19 infection, according to results of a retrospective matched-cohort study published in JAMA Surgery.

In this study, researchers assessed adult patients (n=5053) with BMIs greater than or equal to 35 kg/m² who underwent surgical intervention for weight loss at the Cleveland Clinic Health System in Ohio between January 2004 and December 2017. The researchers sought to determine whether surgical intervention for weight loss decreases the risk for severe COVID-19 in patients with obesity. Patients who underwent surgical intervention for weight loss were matched in a 1:3 ratio against a cohort of patients (controls) who did not undergo the intervention. In addition, the researchers assessed outcomes among a subset of patients from the intervention group (n=2958) and control group (n=8851) who were diagnosed with COVID-19 between March 2020 and March 2021.

Among patients in the intervention and control groups, the median age was 46 (IQR, 37-55) and 46 (IQR, 34-57) years, 76.9% and 77.9% were women, median BMI was 45.5 (IQR, 41.0-51.6) and 45.3 (IQR, 40.8-50.9) kg/m², 73.7% and 73.9% were White, 59.7% and 61.5% had no history of smoking, and the median Charlson Comorbidity Index score was 2.0 (IQR, 1.0-3.0) and 1.0 (IQR, 0-3.0), respectively. Among patients in the intervention group, 66.3% underwent Roux-en-Y gastric bypass and 33.7% underwent sleeve gastrectomy.

At 10 years, the mean total decrease in BMI was 20.8% (95% CI, 20.6-21.0) among patients in the intervention group vs 2.3% (95% CI, 2.1-2.5) among controls (P <.001). Compared with patients in the control group, the rate of all-cause mortality was decreased among those in the intervention group (4.7% vs 9.4%), corresponding with a significantly decreased mortality risk (adjusted hazard ratio [aHR], 0.47; 95% CI, 0.38-0.57; P <.001).

Of note, the rate of COVID-19 infection was increased among patients in the intervention group compared with controls (9.1% vs 8.7%; aHR, 1.03; P =.71).

At the time of COVID-19 infection, patients in the intervention group had decreased BMI (mean difference [MD], 7.9 kg/m²; 95% CI, 6.4-9.5; P <.001) and decreased concentrations of hemoglobin A_1C (MD, 1.2%; 95% CI, 0.8-1.6; P <.001).

Compared with controls, patients in the intervention group who contracted COVID-19 had a decreased risk for hospitalization (15.5% vs 28.2%), requiring supplemental oxygen (9.2% vs 22.3%), severe infection (3.9% vs 9.3%), and death (1.0% vs 3.6%).

Overall, the weight loss intervention was associated with decreased risk for hospitalization due to COVID-19 (aHR, 0.51; 95% CI, 0.35-0.76; P <.001), need for supplemental oxygen (aHR, 0.37; 95% CI, 0.23-0.61; P <.001), and severe COVID-19 (aHR, 0.40; 95% CI, 0.18-0.86; P =.02).

This study may have been biased by the imbalance between the intervention and control groups, as the intervention cohort had an increased COVID-19 risk profile compared with controls.

The researchers concluded, “among patients with obesity, substantial weight loss achieved with surgery, compared with no surgery, was associated with a significantly [decreased] risk [for] hospitalization, need for supplemental oxygen, and severe disease after contracting COVID-19 infection,” indicating that obesity may be a modifiable risk factor for improving COVID-19 outcomes.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Aminian A, Tu C, Milinovich A, Wolski KE, Kattan MW, Nissen SE. Association of weight loss achieved through metabolic surgery with risk and severity of COVID-19 Infection. JAMA Surg. 2021;e216496. doi:10.1001/jamasurg.2021.6496