Impact of the COVID-19 Pandemic on Metabolic and Bariatric Surgery Utilization and Safety in the United States

• Adult bariatric surgery dropped 10.2% from 2019 to 2020, during the first year of the COVID-19 pandemic.
• Adolescent bariatric surgery rose 8.1% over the same period.
• Safety remained comparable to pre-pandemic years; mortality, reoperations and readmissions had been declining steadily in adults since 2015.
• Sepsis and septic shock increased slightly in adults in 2020.

Why This Study Was Needed

In spring 2020, most hospitals paused elective surgery, including bariatric surgery. Obesity was quickly recognized as a major risk factor for severe COVID-19, which made delays in treatment especially concerning. This study measured how much bariatric surgery declined during the first pandemic year and whether it remained safe.

How the Study Was Done

The team analyzed the national MBSAQIP registry from 2015 to 2020, covering 1,134,522 adolescents and adults. They compared surgery volumes and 30-day outcomes before the pandemic (2015–2019) with the first pandemic year (2020).

What the Study Found

• Adult surgery fell 10.2%, from 205,232 operations in 2019 to 167,384 in 2020.
• Adolescent surgery rose 8.1%, from 970 to 1,140 operations.
• Among adults, 30-day mortality, reoperations, readmissions and reinterventions declined steadily from 2015 to 2020.
• Sepsis and septic shock in adults increased in 2020.
• Among teens, reoperations and reinterventions fell over the six years.

What This Means for Patients

Bariatric surgery remained safe during the pandemic, and long-term safety trends continued to improve. Delaying treatment of severe obesity carries its own risks, since diabetes, sleep apnea and high blood pressure keep progressing. Read Is Bariatric Surgery Safe?.

Clinical Pearls

• The pandemic reduced adult bariatric surgery volume by about 10% in 2020.
• Adolescent surgery increased, continuing the rise documented in our JAMA Pediatrics research letter.
• Overall 30-day safety remained comparable to previous years.

Strengths and Limitations

The study uses a large national dataset spanning six years. It captures only the first pandemic year and only 30-day outcomes, and it cannot tell us how patients whose surgery was delayed fared.

Expert Commentary

The pandemic showed how dangerous severe obesity is, and at the same time it delayed treatment for many adults. This study reassured us that bariatric surgery stayed safe, and it showed that families of teenagers continued to seek care even in a very difficult year.

— Dr. Nestor de la Cruz-Muñoz