Bariatric surgery and COVID-19 outcomes: a systematic review and meta-analysis

BACKGROUND: Obesity and its associated complications have a negative impact on human health. Metabolic and bariatric surgery (MBS) ameliorates a series of clinical manifestations associated with obesity. However, the overall efficacy of MBS on COVID-19 outcomes remains unclear. OBJECTIVES: The objective of this article is to analyze the relationship between MBS and COVID-19 outcomes. SETTING: A meta-analysis. METHODS: The PubMed, Embase, Web of Science, and Cochrane Library databases were searched to retrieve the related articles from inception to December 2022. All original articles reporting MBS-confirmed SARS-CoV-2 infection were included. Outcomes including hospital admission, mortality, intensive care unit (ICU) admission, mechanical ventilation utilization, hemodialysis during admission, and hospital stay were selected. Meta-analysis with fixed or random-effect models was used and reported in terms of odds ratios (ORs) or weighted mean differences (WMDs) along with their 95% confidence intervals (CIs). Heterogeneity was assessed with the I(2) test. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS: A total of 10 clinical trials involving the investigation of 150,848 patients undergoing MBS interventions were included. Patients who underwent MBS had a lower risk of hospital admission (OR: .47, 95% CI: .34–.66, I(2) = 0%), mortality (OR: .43, 95% CI: .28–.65, I(2) = 63.6%), ICU admission (OR: .41, 95% CI: .21–.77, I(2) = 0%), and mechanical ventilation (OR: .51, 95% CI: .35–.75, I(2) = 56.2%) than those who did not undergo surgery, but MBS did not affect hemodialysis risk or COVID-19 infection rate. In addition, the length of hospital stay for patients with COVID-19 after MBS was significantly reduced (WMD: −1.81, 95% CI: −3.11–.52, I(2) = 82.7%). CONCLUSIONS: Our findings indicate that MBS is shown to improve COVID-19 outcomes, including hospital admission, mortality, ICU admission, mechanical ventilation, and hospital stay. Patients with obesity who have undergone MBS infected with COVID-19 will have better clinical outcomes than those without MBS.