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Impact of Prior Bariatric Surgery on Mortality in COVID-19 Patients: a Comprehensive Meta-analysis

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Abstract

Obesity has been linked to immunosuppressive effects and increased susceptibility to respiratory infections, including COVID-19. Bariatric surgery (BS) has demonstrated promising results in enhancing a variety of clinical outcomes in obese patients. The purpose of this meta-analysis is to evaluate the effect of BS on COVID-19 outcomes, specifically all-cause mortality. A thorough literature search was conducted in electronic databases to identify pertinent studies through November 2022. Inclusion criteria included retrospective cohort studies that investigated the association between BS and COVID-19 mortality. Data extraction and quality assessment were carried out in accordance with established protocols. A random-effects model was used to calculate the odds ratio (OR) and 95% confidence intervals (CIs). Using I2 statistics, heterogeneity was evaluated, and publication bias was assessed using funnel plots. Eight retrospective studies involving a total cohort of 409,665 patients met the quantitative analysis eligibility criteria. In the crude unmatched analysis, the overall mortality rate among patients with prior BS was significantly lower than among those without BS (OR 0.52; 95% CI [0.43, 0.62]; p = 0.03; I2 = 53.66%). After adjusting for comorbidities, the matched analysis yielded comparable results (OR 0.42, 95% CI [0.25, 0.72], p = 0.14, I2 = 41.88%). Comparing the BS group to the non-BS group, subgroup analyses by country (the USA and Europe) showed that the BS group had a mortality risk that was nearly 50% lower. The funnel plot indicated that there was no publication bias, and the sensitivity analysis revealed balanced results when each study was excluded. This meta-analysis suggests that a history of BS is associated with a decreased risk of deaths from all causes in COVID-19 patients. These results highlight the prospective benefits of BS in mitigating adverse outcomes in obese COVID-19 patients. To investigate the underlying mechanisms and potential confounders of this association, additional research is required.

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Data Availability

All data generated or analyzed during this study are included in this published article.

Code Availability

Not applicable.

Abbreviations

BS :

Bariatric surgery

OR :

Odds ratio

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Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55902, USA

    Aditi Bhanushali

  2. Department of Population Health & Leadership, University of New Haven, West Haven, CT, 06516, USA

    Muskan Kohli & Svaapnika Rao Sarvepalli

  3. Department of Internal Medicine, HCA Florida Westside Hospital, Plantation, FL, 33324, USA

    Ali Tariq Alvi

  4. Department of Medicine, Vydehi Institute of Medical Sciences and Research Center, Bangalore, 560066, India

    Ananya Prakash

  5. Department of Medicine, G.S.V.M. Medical College, Uttar Pradesh, Kanpur, 208002, India

    Anchal Pandey

  6. Department of Medicine, Baroda Medical College & Master of Public Health, Mount Sinai, NY, 10029, USA

    Bansi Trambadia

  7. Department of Medicine, Osmania Medical College, Hyderabad, Telangana, 500095, India

    Sadhu Aishwarya Reddy

  8. Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Geisinger Health System, Wilkes-Barre, PA, 18702, USA

    Shaylika Chauhan

  9. Atlanta, USA

    Rupak Desai

Authors
  1. Aditi Bhanushali
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Contributions

AB: resources, investigation writing - original draft; visualization, writing - review and editing, investigation, formal analysis

MK: methodology, writing, original draft; writing - review and editing, visualization, investigation

SRS: writing - original draft; writing - review and editing, investigation, visualization

ATA: writing - original draft; writing - review and editing, investigation, visualization

AP: writing - original draft; writing - review and editing, investigation, visualization

AP: writing - original draft; writing - review and editing, investigation, visualization

BT: writing - original draft; writing - review and editing, investigation, visualization

SAR: writing - original draft; writing - review and editing, investigation, visualization

SC: conceptualization, methodology, writing - original draft, writing - review and editing, visualization, supervision

RD: conceptualization, methodology, software, formal analysis, resources, writing original draft; writing - review and editing, administration, supervision

All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Shaylika Chauhan.

Ethics declarations

Ethics Approval

Since the data included in this review were deidentified and already available in publicly accessible databases, the IRB review was not mandatory. This review was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Not applicable.

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Not applicable.

Competing Interests

The authors declare no competing interests.

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This article is part of the Topical Collection on Medicine

Study Highlights

• Bariatric surgery (BS) is associated with a significantly lower risk (OR 0.52) of all-cause mortality in COVID-19 patients.

• The meta-analysis includes data from eight studies involving 409,665 patients, providing robust statistical power.

• BS shows consistent mortality risk reduction in both the USA and Europe.

• No publication bias was detected, and results remain stable in sensitivity analysis.

• BS offers potential benefits in reducing adverse outcomes for obese COVID-19 patients, warranting further investigation.

Supplementary Information

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Supplementary file1 (XLSX 27.9 KB)

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Bhanushali, A., Kohli, M., Sarvepalli, S.R. et al. Impact of Prior Bariatric Surgery on Mortality in COVID-19 Patients: a Comprehensive Meta-analysis. SN Compr. Clin. Med. 6, 8 (2024). https://doi.org/10.1007/s42399-023-01633-7

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