TY - JOUR
T1 - Bariatric and metabolic surgery during and after the COVID-19 pandemic
T2 - DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery
AU - Rubino, Francesco
AU - Cohen, Ricardo V.
AU - Mingrone, Geltrude
AU - le Roux, Carel W.
AU - Mechanick, Jeffrey I.
AU - Arterburn, David E.
AU - Vidal, Josep
AU - Alberti, George
AU - Amiel, Stephanie A.
AU - Batterham, Rachel L.
AU - Bornstein, Stefan
AU - Chamseddine, Ghassan
AU - Del Prato, Stefano
AU - Dixon, John B.
AU - Eckel, Robert H.
AU - Hopkins, David
AU - McGowan, Barbara M.
AU - Pan, An
AU - Patel, Ameet
AU - Pattou, François
AU - Schauer, Philip R.
AU - Zimmet, Paul Z.
AU - Cummings, David E.
PY - 2020/7
Y1 - 2020/7
N2 - The coronavirus disease 2019 pandemic is wreaking havoc on society, especially health-care systems, including disrupting bariatric and metabolic surgery. The current limitations on accessibility to non-urgent care undermine postoperative monitoring of patients who have undergone such operations. Furthermore, like most elective surgery, new bariatric and metabolic procedures are being postponed worldwide during the pandemic. When the outbreak abates, a backlog of people seeking these operations will exist. Hence, surgical candidates face prolonged delays of beneficial treatment. Because of the progressive nature of obesity and diabetes, delaying surgery increases risks for morbidity and mortality, thus requiring strategies to mitigate harm. The risk of harm, however, varies among patients, depending on the type and severity of their comorbidities. A triaging strategy is therefore needed. The traditional weight-centric patient-selection criteria do not favour cases based on actual clinical needs. In this Personal View, experts from the Diabetes Surgery Summit consensus conference series provide guidance for the management of patients while surgery is delayed and for postoperative surveillance. We also offer a strategy to prioritise bariatric and metabolic surgery candidates on the basis of the diseases that are most likely to be ameliorated postoperatively. Although our system will be particularly germane in the immediate future, it also provides a framework for long-term clinically meaningful prioritisation.
AB - The coronavirus disease 2019 pandemic is wreaking havoc on society, especially health-care systems, including disrupting bariatric and metabolic surgery. The current limitations on accessibility to non-urgent care undermine postoperative monitoring of patients who have undergone such operations. Furthermore, like most elective surgery, new bariatric and metabolic procedures are being postponed worldwide during the pandemic. When the outbreak abates, a backlog of people seeking these operations will exist. Hence, surgical candidates face prolonged delays of beneficial treatment. Because of the progressive nature of obesity and diabetes, delaying surgery increases risks for morbidity and mortality, thus requiring strategies to mitigate harm. The risk of harm, however, varies among patients, depending on the type and severity of their comorbidities. A triaging strategy is therefore needed. The traditional weight-centric patient-selection criteria do not favour cases based on actual clinical needs. In this Personal View, experts from the Diabetes Surgery Summit consensus conference series provide guidance for the management of patients while surgery is delayed and for postoperative surveillance. We also offer a strategy to prioritise bariatric and metabolic surgery candidates on the basis of the diseases that are most likely to be ameliorated postoperatively. Although our system will be particularly germane in the immediate future, it also provides a framework for long-term clinically meaningful prioritisation.
UR - http://www.scopus.com/inward/record.url?scp=85084617128&partnerID=8YFLogxK
U2 - 10.1016/S2213-8587(20)30157-1
DO - 10.1016/S2213-8587(20)30157-1
M3 - Review Article
C2 - 32386567
AN - SCOPUS:85084617128
SN - 2213-8587
VL - 8
SP - 640
EP - 648
JO - The Lancet Diabetes and Endocrinology
JF - The Lancet Diabetes and Endocrinology
IS - 7
ER -