Our survey showed that bariatric patients have different points of view regarding the possibility of undergoing bariatric surgery during the pandemic.
Despite international recommendations to postpone elective surgery until after the epidemic, [7] there is a large proportion of patients who would like to continue bariatric surgical treatment. Nearly half of bariatric patients would positively decide about their bariatric surgery during COVID-19 pandemic, more than two thirds of pre-operative patients wanted to undergo surgery despite higher risk of severe coronavirus infection course.
Women, compared to men are less susceptible to viral infections based on a better innate immunity, levels of steroid hormones and factors related to sex chromosomes. [8] Despite the similar incidence of COVID-19 infection in both sexes, men have a worse prognosis.[9] In our study, among all the responders men were more likely to decide about undergoing bariatric surgery, but in group of pre-operative patients the result was opposite.
A higher number of comorbidities, in particular type 2 diabetes, arthrosis and joint pain had a positive correlation with a decision about bariatric surgery in present situation. Contrarily, among the group of preoperative patients, patients hoping for surgery during the pandemic had fewer comorbidities and less often suffered from type 2 diabetes, insulin resistance or osteoarthritis. Both patients scheduled for bariatric surgery in a COVID-19 treating center and those who felt more anxiety/fear due to pandemic would rather not decide about operative treatment during pandemic. Although lockdown and isolation undoubtedly negatively affected dietary regimens, daily physical exercises and often resulted in increase in body weight, these factors did not significantly influence the decision of undergoing bariatric surgery in time of increased epidemiological risk. Only a small number of patients reported health deterioration during the pandemic, but this fact did not affect their decision about the surgery.
Obesity is known to increase the vulnerability to infections and there are already studies suggesting that higher BMI is associated with an impairment of curability of may be a risk factor for COVID-19 disease and related mortality. [10,11,12] In our study, patients with higher BMI were more likely to decide positively about the operation despite for pandemic; contrarily, the subgroup of pre-operative patients had an opposite opinion.
Simonnet et al. reported a higher prevalence of obese patients in the group with severe acute respiratory COVID-19 syndrome who required invasive mechanical ventilation. [13] In our study, about 75% of patients who were positive about undergoing operation during pandemic, were aware of worse postoperative course in case of coronavirus infection.
Telemedicine allows to personal contact and decreases the risk of COVID-19 infection transmission; therefore, in this peculiar period telemedicine got promoted to a new level of utility. [14] In our study, more than a half patients before bariatric surgery had remote access to the doctors providing bariatric treatment and profited from online support groups during the pandemic, although these possibilities did not influence their decision about bariatric surgery during the current epidemiological situation.
It has taken China around 100 days to start getting back to ‘normal’ and early signals from other countries follow, seemingly indicating a slowdown of the pace of pandemic. [15] In most countries the morbidity is still rising and it cannot be predicted how long the pandemic and the consequent restrictions on the elective surgery will last.
There are couple of limitations associated with this publication. The study include recallbias and the subjectivity of patients in stating their opinions. The survey was limited to members of the Polish Association of Bariatric Patients (CHLO) that is why may not reflect the entire bariatric population.