Abstract
Background
Age ≥ 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort.
Methods
We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups — patients ≥ 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality.
Results
There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 ± 2.5 years, 119.5 ± 24.5 kg, and 43 ± 7 in Group I and 39.8 ± 11.3 years, 117.7±20.4 kg, and 43.7 ± 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001).
The 30-day morbidity was significantly higher in Group I (11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups.
Conclusions
Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those ≥ 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups.
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Introduction
Bariatric surgery is currently the only evidence-based durable treatment option for patients with obesity and related comorbidities. An ageing population worldwide presents a challenge to all healthcare practitioners, including those involved in providing obesity management services [1, 2]. Previously, advanced age was considered a relative contraindication for bariatric surgery [3]. However, the evolution of laparoscopic techniques and advances in perioperative care protocols have changed perceptions [4, 5].
While some studies confirm good weight loss and acceptable postoperative morbidity and mortality in older individuals, others show significant perioperative morbidity and mortality with varying weight loss results [6,7,8]. Additionally, the heterogeneity of the studies with different age cutoff points and definitions of the older patients’ population prevents the generalisation of these results [9, 10].
Older age is associated with an unfavourable prognosis with COVID-19 should a patient undergoing bariatric surgery develop perioperative COVID-19 infection. At the same time, obesity and its associated comorbidities also increase the risk of adverse outcomes with COVID-19 [11,12,13]. This poses a dilemma for healthcare professionals dealing with older patients seeking bariatric surgery.
The present study aimed to understand the safety of bariatric surgery in ≥ 65-years-old patients during the COVID-19 pandemic. This study was a subset analysis of the GENEVA dataset; a global study aimed to prospectively assess the safety of bariatric surgery during the COVID-19 pandemic [14,15,16].
Methods
Study Design, Setting, and Population
The GENEVA study was a global, multicentre, observational study of Bariatric Surgery (elective primary, elective revisional, and emergency) performed between 1/05/2020 and 31/10/2020 in the adult (≥ 18 years) population. The detailed methods have been described elsewhere [14,15,16].
We used 65 years as a cutoff point to define the older age group as per the World Health Organisation and The National Institute for Health and Care Excellence (NICE) definitions [17, 18]. We divided patients undergoing primary BS into two groups — those ≥ 65 years old (Group I) and those < 65 years old (Group II). The two groups were compared with each other with regard to basic demographics, 30-day morbidity and mortality, postoperative symptomatic COVID-19 infection rates, and procedure choice.
The main outcome measures of this study were 30-day all-cause and COVID-19 specific morbidity and mortality. Continuous data were presented as mean ± standard deviation (SD) or median (IQR) depending on data distribution. Frequencies were used to summarise categorical variables. Independent t-test or Mann Whitney U test examined differences between continuous variables depending on data distribution. A chi-square test or Fisher’s exact test was used to compare categorical variables. Significance levels were set at p < 0.05. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) statistical software, version 27.0 (SPSS Inc).
Results
Data were collected from 179 centres in 42 countries by 470 surgeons (Appendix 1). Seven thousand ninety-two adult patients who underwent primary BS between 01/05/2020 and 31/10/2020 were included. Complete 30-day morbidity and mortality data were available for 7084 (99.88%) patients. The mean age of the entire cohort was 40.35 ± 11.9 years, and 5197 (73.4%) were females. The mean preoperative weight and body mass index (BMI) was 119.49 ± 24.4 Kg and 43.03 ± 6.9 Kg/m2, respectively.
Table 1 compares the demographics of the two groups. The mean age for group I was 67.6 ± 2.5 years, and for group II was 39.8 ± 11.3 years. Group I included more patients of white ethnicity (84.6%) than Group II (74.3%) (p = 0.004). The rest of the demographic parameters, including pre-operative BMI and weight, were comparable between the two groups (Table 1).
Table 2 details the prevalence of comorbidities and smoking status in the two groups. Nearly 95% of patients in Group I had at least one co-morbidity compared to 68% of patients in Group II (p = < 0.001). Specifically, a significantly greater proportion of patients in Group I suffered from diabetes mellitus (DM) (48.3% vs 20.2%), hypertension (74.5% vs 29.9%), obstructive sleep apnoea requiring continuous positive airway pressure (CPAP) therapy (25.5% vs 13.1%), and hypercholesterolemia (41.6% vs 21.1%) compared to Group II (all comparisons p = < 0.001) (Table 2). In Group II, 14.8% of patients were current smokers, compared to 7.4% of Group I (p = <0.001).
The most common operation type in both groups was laparoscopic sleeve gastrectomy (LSG) (Group 1: 51.0%; Group 2: 56.4%). This was followed by Roux-en-Y gastric bypass (RYGB) (Group 1: 32.9%; Group 2: 29.4%) and one-anastomosis gastric bypass (OAGB) (Group 1: 8.7%; Group 2: 10.0%). Other forms of procedures were performed in 7.4% (Group 1) and 4.2% (Group 2) of individuals. There were no significant differences in procedure choice between the two groups (p = 0.164) (Table 3).
There were significantly more complications in Group I (11.4%) compared to Group II (6.6%) (p = 0.022; Table 4). There was one (0.7%) mortality in Group I and eight (0.1%) in Group II (p = 0.17 on Fisher’s exact test). Additionally, 38 (0.5%) patients in Group II had symptomatic COVID-19 infection within 30 days of the surgical operation compared to none in Group I (p = 1.000).
Table 5 presents 30-day morbidity and mortality analysed by procedure type in both groups. Differences in morbidity and mortality were only significant for LSG.
Discussion
This study has demonstrated that 30-day morbidity was significantly higher for patients ≥ 65 years of age receiving bariatric surgery compared to those < 65 years of age during the COVID-19 pandemic. However, there was no significant difference in 30-day mortality or 30-day symptomatic postoperative COVID-19 infection rates between the two groups.
The finding of increased 30-day morbidity in patients ≥ 65 years old maybe because 94.6% of patients in Group I had at least one co-morbidity compared to 68.3% in Group II. This is similar to the findings by Susmallian et al. who identified that 77% of patients ≥ 65 years of age had at least one comorbidity [7]. Similarly, Bhandari et al. demonstrated that 47.3%, 84.2%, and 17.9% of patients ≥ 65 years old suffered from diabetes, hypertension, and coronary heart disease compared to 20.1%, 23.4%, and 3.8%, respectively, in the younger age group [19].
The 30-day morbidity in our series was significantly higher in the older patients at 11.4% compared to 6.6% in the younger age group. A previous analysis of the National Surgical Quality Improvement Program (NSQIP) database demonstrated similar findings with increased rates of serious morbidity in the older age group compared to younger patients [20]. Another study reported a higher overall complication rate of 8.42% in older patients compared to 5.59% in the younger group, with significant differences in CD grades 3B and 4A [7].
In the current study, there was one mortality in the older age group (n = 149) and eight in the younger group (n = 6923), representing 0.7% and 0.1%, respectively. Though the difference did not reach statistical significance, this may be due to the small sample size. Bariatric teams should, therefore, be careful in offering bariatric surgery to patients in this age group. In contrast, a recent meta-analysis found that the mortality rate after LSG was similar at 0.2% in patients > 60 years and those ≤ 60 years of age whereas the mortality after RYGB was 2.2% and 0% (0/182), respectively [21]. However, those authors used 60 years as the cutoff which is no longer used to define older patients by WHO and other such bodies.
LSG was unsurprisingly the most commonly performed operation type in both groups (Group 1: 51.0%; Group 2: 56.4%) (Table 3). Importantly, there were no significant differences in procedure choice between the two groups. Although the 30-day morbidity was significantly higher for LSG with Group I (15.8% vs 5.7%), it is difficult to draw firm conclusions from this due to the relatively low patient numbers (n = 76). All other procedures had comparable morbidity rates in both groups but once again there is potential for type II error due to small numbers. We cannot make any justifiable conclusions regarding morbidity and mortality of different procedures in two groups based on the data in our study. Authors would however suggest that procedure selection is made in the usual manner on an individualised basis for each patient taking into account their wishes and specific characteristics.
Strengths and Weaknesses
This study has several weaknesses. Firstly, it only included data from participating centres and might therefore not represent the complete global picture. Additionally, we cannot guarantee that all contributors submitted all their consecutive patients during the study period, though collaborators were repeatedly reminded to do so. It is also possible that all adverse outcomes were not reported, but it is hoped that anonymous data collection and reporting would have discouraged any underreporting. Lastly, there were only 149 patients in the older age group, meaning that there is a potential for Type II error concerning the difference in mortality which indeed appears to be higher in the older population (0.7% vs 0.1%).
At the same time, this is the first international study examining the safety of bariatric surgery in those ≥ 65 years of age during the COVID-19 pandemic, which is known to have affected older people disproportionately. Moreover, this study included a broad range of patients representing a wide range of demographics, geographical distribution, stage of COVID-19 pandemic severity in the host population, and surgeon and centre experiences. Other strengths of this study include the large sample size, the global reach of the study, high data completion rate, and nearly complete follow-up.
Conclusion
Bariatric surgery during the COVID-19 pandemic was associated with higher 30-day morbidity in older patients (≥ 65 years old) compared to younger patients. The mortality and postoperative COVID-19 infection rates were comparable to the younger age group.
Author Contribution
RS: conceptualization, methodology, investigation, formal analysis. IO: formal analysis, writing — original draft preparation, discussion of the results, writing — review & editing. BM, YR, YG, AAT, CL, and TW: investigation, data curation. KM: conceptualization, methodology, writing — review & editing, supervision. All authors have seen the final manuscript and approved it. The study was designed and conducted by the study group and the authors on behalf of GENEVA collaborators.
Data Statement
The data used to support the findings of this study can be released upon request.
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Geneva Collaborators
1 Michał Pędziwiatr 2'nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
2 Piotr Major 2'nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
3 Piotr Zarzycki 2'nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
4 Athanasios Pantelis 4th Surgical Department, Evaggelismos General Hospital of Athens, Athens, Greece
5 Dimitris P. Lapatsanis 4th Surgical Department, Evaggelismos General Hospital of Athens, Athens, Greece
6 Georgios Stravodimos 4th Surgical Department, Evaggelismos General Hospital of Athens, Athens, Greece
7 Chris Matthys A Z Sint Elisabeth Zottegem, Belgium
8 Marc Focquet A Z Sint Elisabeth Zottegem, Belgium
9 Wouter Vleeschouwers A Z Sint Elisabeth Zottegem, Belgium
10 Antonio G Spaventa ABC Medical Center Santa Fe, Mexico City, Mexico
11 Carlos Zerrweck ABC Medical Center Santa Fe, Mexico City, Mexico
12 Antonio Vitiello Advanced Biomedical Sciences Department - Naples “Federico II” University - Italy
13 Giovanna Berardi Advanced Biomedical Sciences Department - Naples “Federico II” University - Italy
14 Mario Musella Advanced Biomedical Sciences Department - Naples “Federico II” University - Italy
15 Alberto Sanchez-Meza Advanced Medicine Institute. Reynosa, MEXICO
16 Felipe J Cantu Jr Advanced Medicine Institute. Reynosa, MEXICO
17 Fernando Mora Advanced Medicine Institute. Reynosa, MEXICO
18 Marco A Cantu Advanced Medicine Institute. Reynosa, MEXICO
19 Abhishek Katakwar AIG hospital, Hyderabad, India
20 D Nageshwar Reddy AIG hospital, Hyderabad, India
21 Haitham Elmaleh Ain Shams University Hospitals
22 Mohammad Hassan Ain Shams University Hospitals
23 Abdelrahman Elghandour Ain Shams University Hospitals
24 Mohey Elbanna Ain Shams University Hospitals
25 Ahmed Osman Ain Shams University Hospitals, Cairo, Egypt
26 Athar Khan Al shark hospital fujairah UAE
27 Laurent layani Al shark hospital fujairah UAE
28 Nalini kiran Al shark hospital fujairah UAE
29 Andrey Velikorechin American Medical Clinic, Saint Petersburg, Russia
30 Maria Solovyeva American Medical Clinic, Saint Petersburg, Russia
31 Hamid Melali Amin University Hospital, Isfahan, Iran
32 Shahab Shahabi Amin University Hospital, Isfahan, Iran
33 Ashish Agrawal Apoorv Hi Tech at Gokuldas Hospital
34 Apoorv Shrivastava Apoorv Hi Tech at Gokuldas Hospital
35 Ankur Sharma Asian Bariatrics, Ahmedabad, India
36 Bhavya Narwaria Asian Bariatrics, Ahmedabad, India
37 Mahendra Narwaria Asian Bariatrics, Ahmedabad, India
38 Asnat Raziel Assuta Medical Center, Tel Aviv, Israel
39 Nasser Sakran Assuta Medical Center, Tel Aviv, Israel
40 Sergio Susmallian Assuta Medical Center, Tel Aviv, Israel
41 Levent Karagöz Atasam Hospitals,Samsun,Turkey
42 Murat Akbaba Atasam Hospitals,Samsun,Turkey
43 Salih Zeki Pişkin Atasam Hospitals,Samsun,Turkey
44 Ahmet Ziya BALTA AZBariatrics Obesity Center, Istanbul
45 Zafer Senol AZBariatrics Obesity Center, Istanbul
46 Emilio Manno Bariatric and Metabolic surgery UnitOspedale A.Cardarelli Napoli Italia
47 Michele Giuseppe Iovino Bariatric and Metabolic surgery UnitOspedale A.Cardarelli Napoli Italia
48 Ahmed Osman Bariatric Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
49 Mohamed Qassem Bariatric Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
50 Sebastián Arana-Garza Bariatric Surgery Experts, Monterrey, Mexico
51 Heitor P. Povoas BAROS - Bariatric and Metabolic Surgery, Salvador, Brazil
52 Marcos Leão Vilas-Boas BAROS - Bariatric and Metabolic Surgery, Salvador, Brazil
53 Alan Li BMI Alexandra Hospital, Manchester, UK
54 Basil J Ammori Burjeel Hospital, Abu Dhabi, UAE
55 Hany Balamoun Cairo University, Cairo, Egypt
56 Mohammed Salman Cairo University, Cairo, Egypt
57 Amrit Manik Nasta Center of Metabolic Surgery, Wockhardt Hospital, Agripada, Mumbai, India
58 Ramen Goel Center of Metabolic Surgery, Wockhardt Hospital, Agripada, Mumbai, India
59 Hugo Sánchez-Aguilar Center of Nutrition and Obesity, ABC Medical Center (Observatorio), Mexico City
60 Miguel F Herrera Center of Nutrition and Obesity, ABC Medical Center (Observatorio), Mexico City
61 Adel ABOU-MRAD Centre Hospitalier Regional d'ORLEANS
62 Lucie CLOIX Centre Hospitalier Regional d'ORLEANS
63 Guilherme Silva Mazzini Centro de Obesidade do Instituto do Aparelho Digestivo, Porto Alegre, Brazil
64 Leonardo Kristem Centro de Obesidade do Instituto do Aparelho Digestivo, Porto Alegre, Brazil
65 Andre Lazaro Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
66 Jose Campos Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
67 Joaquín Bernardo Centro Médico de Asturias. Oviedo. Spain
68 Jesús González Centro Médico de Asturias. Oviedo. Spain
69 Carlos Trindade Centro Multidisciplinar da Doença Metabólica, Clínica Santo Antonio - Lusiadas, Amadora, Portugal
70 Octávio Viveiros Centro Multidisciplinar da Doença Metabólica, Clínica Santo Antonio - Lusiadas, Amadora, Portugal
71 Rui Ribeiro Centro Multidisciplinar da Doença Metabólica, Clínica Santo Antonio - Lusiadas, Amadora, Portugal
72 David Goitein Chaim Sheba Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
73 David Hazzan Chaim Sheba Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
74 Lior Segev Chaim Sheba Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
75 Tamar Beck Chaim Sheba Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
76 Hernán Reyes Christus Muguerza Sur, Monterrey, Mexico
77 Jerónimo Monterrubio Christus Muguerza Sur, Monterrey, Mexico
78 Paulina García Christus Muguerza Sur, Monterrey, Mexico
79 Marine Benois CHU Félix Guyon, la Réunion, France
80 Radwan Kassir CHU Félix Guyon, la Réunion, France
81 Alessandro Contine Città di Castello Hospital, Usl Umbria 1, Città di Castello - Italy
82 Moustafa Elshafei Clinic for Metabolic Surgery, Krankenhaus Nordwest, Frankfurt, Germany
83 Sueleyman Aktas Clinic for Metabolic Surgery, Krankenhaus Nordwest, Frankfurt, Germany
84 Sylvia Weiner Clinic for Metabolic Surgery, Krankenhaus Nordwest, Frankfurt, Germany
85 Till Heidsieck Clinic for Metabolic Surgery, Krankenhaus Nordwest, Frankfurt, Germany
86 Luis Level Clínica Santa Sofía, Caracas, Venezuela
87 Silvia Pinango Clínica Santa Sofía, Caracas, Venezuela
88 Patricia Martinez Ortega Clinica Universidad de Navarra. Pamplona. Spain
89 Rafael Moncada Clinica Universidad de Navarra. Pamplona. Spain
90 Victor Valenti Clinica Universidad de Navarra. Pamplona. Spain
91 Ivan Vlahović Clinical Hospital Centre Osijek, Osijek, Croatia
92 Zdenko Boras Clinical Hospital Centre Osijek, Osijek, Croatia
93 Arnaud Liagre Clinique des Cedres, Cornebarrieu, France
94 Francesco Martini Clinique des Cedres, Cornebarrieu, France
95 Gildas Juglard Clinique des Cedres, Cornebarrieu, France
96 Manish Motwani COMS, Apollo Spectra Hospital, New Delhi, India
97 Sukhvinder Singh Saggu COMS, Apollo Spectra Hospital, New Delhi, India
98 Hazem Al Momani Danat Al Emarat Hospital, Abu Dhabi, UAE
99 Luis Adolfo Aceves López Defeat Obesity Bariatric and Metabolic Surgery, CHRISTUS MUGUERZA Hospital Reynosa, Reynosa, Tamaulipas.
100 María Angelina Contreras Cortez Defeat Obesity Bariatric and Metabolic Surgery, CHRISTUS MUGUERZA Hospital Reynosa, Reynosa, Tamaulipas.
101 Rodrigo Aceves Zavala Defeat Obesity Bariatric and Metabolic Surgery, CHRISTUS MUGUERZA Hospital Reynosa, Reynosa, Tamaulipas.
102 Christine D'Haese RN Delta CHIREC hospital, Brussels Belgium
103 Ivo Kempeneers Delta CHIREC hospital, Brussels Belgium
104 Jacques Himpens Delta CHIREC hospital, Brussels Belgium
105 Andrea Lazzati Department of General Surgery, Center Hospitalier Intercommunal de Créteil, Paris, France
106 Luca Paolino Department of General Surgery, Center Hospitalier Intercommunal de Créteil, Paris, France
107 Sarah Bathaei Department of General Surgery, Center Hospitalier Intercommunal de Créteil, Paris, France
108 Abdulkadir Bedirli Department of General Surgery, Gazi University Faculty of Medicine, Turkey
109 Aydın Yavuz Department of General Surgery, Gazi University Faculty of Medicine, Turkey
110 Çağrı Büyükkasap Department of General Surgery, Gazi University Faculty of Medicine, Turkey
111 Safa Özaydın Department of General Surgery, Gazi University Faculty of Medicine, Turkey
112 Andrzej Kwiatkowski Department of General Surgery, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw, Poland
113 Katarzyna Bartosiak Department of General Surgery, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw, Poland
114 Maciej Walędziak Department of General Surgery, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw, Poland
115 Antonella Santonicola Department of Public Health, “Federico II” University of Naples, Naples, Italy
116 Luigi Angrisani Department of Public Health, “Federico II” University of Naples, Naples, Italy
117 Paola Iovino Department of Public Health, “Federico II” University of Naples, Naples, Italy
118 Rossella Palma Department of Public Health, “Federico II” University of Naples, Naples, Italy
119 Angelo Iossa Division of General Surgery & Bariatric Center of Excellence IFSO-EC, University La Sapienza of Rome, Italy
120 Cristian Eugeniu Boru Division of General Surgery & Bariatric Center of Excellence IFSO-EC, University La Sapienza of Rome, Italy
121 Francesco De Angelis Division of General Surgery & Bariatric Center of Excellence IFSO-EC, University La Sapienza of Rome, Italy
122 Gianfranco Silecchia Division of General Surgery & Bariatric Center of Excellence IFSO-EC, University La Sapienza of Rome, Italy
123 Abdulzahra Hussain Doncaster and Bassetlaw Teaching Hospitals
124 Srivinasan Balchandra Doncaster and Bassetlaw Teaching Hospitals
125 Izaskun Balciscueta Coltell Dr. Lorenzo, Innovación Cirugía Obesidad y Diabetes
126 Javier Lorenzo Pérez Dr. Lorenzo, Innovación Cirugía Obesidad y Diabetes
127 Ashok Bohra East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK
128 Altaf K Awan East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK
129 Brijesh Madhok East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK
130 Paul C Leeder East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK
131 herif Awad East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK
132 Waleed Al-Khyatt East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK
133 Ashraf Shoma Elsafa Private Hospital & Mansoura University Hospital & Eldelta Hospital
134 Hosam Elghadban Elsafa Private Hospital & Mansoura University Hospital & Eldelta Hospital
135 Sameh Ghareeb Elsafa Private Hospital & Mansoura University Hospital & Eldelta Hospital
136 Bryan Mathews ew York Minimally Invasive Surgery PLLC, New York, NY , USA
137 Marina Kurian ew York Minimally Invasive Surgery PLLC, New York, NY , USA
138 Andreas Larentzakis First Department of Propaedeutic Surgery, Hippocration General Athens Hospital, National and Kapodistrian University of Athens, Athens, Greece
139 Gavriella Zoi Vrakopoulou First Department of Propaedeutic Surgery, Hippocration General Athens Hospital, National and Kapodistrian University of Athens, Athens, Greece
140 Konstantinos Albanopoulos First Department of Propaedeutic Surgery, Hippocration General Athens Hospital, National and Kapodistrian University of Athens, Athens, Greece
141 Ahemt Bozdag Fırat University Hospital, Elazığ. Turkey
142 Azmi Lale Fırat University Hospital, Elazığ. Turkey
143 Cuneyt Kirkil Fırat University Hospital, Elazığ. Turkey
144 Mursid Dincer Fırat University Hospital, Elazığ. Turkey
145 Ahmad Bashir Gastrointestinal, Bariatric & Metabolic Center at Jordan Hospital, Amman, Jordan
146 Ashraf Haddad Gastrointestinal, Bariatric & Metabolic Center at Jordan Hospital, Amman, Jordan
147 Leen Abu Hijleh Gastrointestinal, Bariatric & Metabolic Center at Jordan Hospital, Amman, Jordan
148 Bruno Zilberstein GASTROMED-Zilberstein Institute, Sao Paulo, Brazil
149 Danilo Dallago de Marchi GASTROMED-Zilberstein Institute, Sao Paulo, Brazil
150 Willy Petrini Souza GASTROMED-Zilberstein Institute, Sao Paulo, Brazil
151 Carl Magnus Brodén GB Obesitas Skaane, Malmö. Sweden.
152 Hjörtur Gislason GB Obesitas Skaane, Malmö. Sweden.
153 Kamran Shah GB Obesitas Skaane, Malmö. Sweden.
154 Antonio Ambrosi General Surgery, University of Foggia. Italy.
155 Giovanna Pavone General Surgery, University of Foggia. Italy.
156 Nicola Tartaglia General Surgery, University of Foggia. Italy.
157 S Lakshmi Kumari Kona Glenagles Global Hospital, Lakdikapul, Hyderabad
158 Kalyan K Glenagles Global Hospital, Lakdikapul, Hyderabad
159 Cesar Ernesto Guevara Perez Grammo SAS IPS, Bogotá, Colombia
160 Miguel Alberto Forero Botero Grammo SAS IPS, Bogotá, Colombia
161 Adrian Covic Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
162 Daniel Timofte Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
163 Madalina Maxim Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
164 Dashti Faraj Groene Hart Hospital in Gouda & Dutch Obesity Clinic The Hague, Netherlands
165 Larissa Tseng Groene Hart Hospital in Gouda & Dutch Obesity Clinic The Hague, Netherlands
166 Ronald Liem Groene Hart Hospital in Gouda & Dutch Obesity Clinic The Hague, Netherlands
167 Gürdal Ören Gürdal Ören Bariatric Surgery Center, İstanbul, Turkey
168 Evren Dilektasli Hayat Hospital, General Surgery, Bariatric & Metabolic Surgery , Bursa , Turkey
169 Ilker Yalcin Hayat Hospital, General Surgery, Bariatric & Metabolic Surgery , Bursa , Turkey
170 Hudhaifa AlMukhtar Healthpoint Hospital, Abu Dhabi, UAE
171 Mohammed Al Hadad Healthpoint Hospital, Abu Dhabi, UAE
172 Rasmi Mohan Healthpoint Hospital, Abu Dhabi, UAE
173 Naresh Arora HOPE OBESITY CENTRE, AHMEDABAD, INDIA
174 Digvijaysingh Bedi HOPE OBESITY CENTRE, AHMEDABAD, INDIA
175 Claire Rives-Lange Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
176 Jean-Marc Chevallier Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
177 Tigran Poghosyan Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
178 Hugues Sebbag Hôpital Privé de Provence (HPP), Aix-en-Provence, France
179 Lamia Zinaï Hôpital Privé de Provence (HPP), Aix-en-Provence, France
180 Saadi Khaldi Hôpital Privé de Provence (HPP), Aix-en-Provence, France
181 Charles Mauchien Hôpital Ste Musse Centre Hospitalier Toulon
182 Davide Mazza Hôpital Ste Musse Centre Hospitalier Toulon
183 Georgiana Dinescu Hôpital Ste Musse Centre Hospitalier Toulon
184 Bernardo Rea Hospital Ángeles Lomas, Estado de México, México
185 Fernando Pérez-Galaz Hospital Ángeles Lomas, Estado de México, México
186 Luis Zavala Hospital Christus Muguerza Sur - Monterrey México
187 Anais Besa Hospital Clínic de Barcelona, Barcelona, Spain
188 Anna Curell Hospital Clínic de Barcelona, Barcelona, Spain
189 Jose M Balibrea Hospital Clínic de Barcelona, Barcelona, Spain
190 Carlos Vaz Hospital CUF Tejo, Lisbon, Portugal
191 Luis Galindo Hospital CUF Tejo, Lisbon, Portugal
192 Nelson Silva Hospital CUF Tejo, Lisbon, Portugal
193 José Luis Estrada Caballero Hospital General Universitario Alicante Spain
194 Sergio Ortiz Sebastian Hospital General Universitario Alicante Spain
195 João Caetano Dallegrave Marchesini Hospital Marcelino Champagnat, Curitiba, Brazil
196 Ricardo Arcanjo da Fonseca Pereira Hospital Marcelino Champagnat, Curitiba, Brazil
197 Wagner Herbert Sobottka Hospital Marcelino Champagnat, Curitiba, Brazil
198 Felipe Eduardo Fiolo Hospital Privado de Comunidad - Mar del Plata - Argentina
199 Matias Turchi Hospital Privado de Comunidad - Mar del Plata - Argentina
200 Antonio Claudio Jamel Coelho Hospital Rios D'Or , Rio de Janeiro, Brazil
201 Andre Luis Zacaron Hospital Rios D'Or , Rio de Janeiro, Brazil
202 André Barbosa Hospital Unimed Natal, Natal, Brazil
203 Reynaldo Quinino Hospital Unimed Natal, Natal, Brazil
204 Gabriel Menaldi Hospital Universitario Austral, Bariatric and Metabolic department. Buenos Aires Argentina
205 Nicolás Paleari Hospital Universitario Austral, Bariatric and Metabolic department. Buenos Aires Argentina
206 Pedro Martinez-Duartez Hospital Universitario Austral, Bariatric and Metabolic department. Buenos Aires Argentina
207 Gabriel Martínez de Aragon Ramírez de Esparza Hospital Universitario de Álava, Vitoria- Gasteiz. Spain
208 Valentin Sierra Esteban Hospital Universitario de Álava, Vitoria- Gasteiz. Spain
209 Antonio Torres Hospital Universitario Madrid Monteprincipe. Hospital Clinico San Carlos. Madrid
210 Jose Luis Garcia-Galocha Hospital Universitario Madrid Monteprincipe. Hospital Clinico San Carlos. Madrid
211 MIguel Josa Hospital Universitario Madrid Monteprincipe. Hospital Clinico San Carlos. Madrid
212 Jose Manuel Pacheco-Garcia Hospital Universitario Puerta del Mar. Cadiz. Spain
213 Maria Angeles Mayo-Ossorio Hospital Universitario Puerta del Mar. Cadiz. Spain
214 Pradeep Chowbey Institute of Minimal Access, Metabolic & Bariatric Surgery, Max Super-Speciality Hospital, Saket, New Delhi, India
215 Vandana Soni Institute of Minimal Access, Metabolic & Bariatric Surgery, Max Super-Speciality Hospital, Saket, New Delhi, India
216 Hercio Azevedo de Vasconcelos Cunha Instituto Campineiro de Tratamento da Obesidade, Campinas, Brazil
217 Michel Victor Castilho Instituto Campineiro de Tratamento da Obesidade, Campinas, Brazil
218 Rafael Meneguzzi Alves Ferreira Instituto Campineiro de Tratamento da Obesidade, Campinas, Brazil
219 Thiago Alvim Barreiro Instituto Campineiro de Tratamento da Obesidade, Campinas, Brazil
220 Alexandros Charalabopoulos Interbalcan Medical Center
221 Elias Sdralis Interbalcan Medical Center
222 Spyridon Davakis Interbalcan Medical Center
223 Benoit Bomans International School Reduced Scar Laparoscopy, Brussels, Belgium
224 Giovanni Dapri International School Reduced Scar Laparoscopy, Brussels, Belgium
225 Koenraad Van Belle International School Reduced Scar Laparoscopy, Brussels, Belgium
226 MazenTakieddine Isppc chu -André Vésale , metabolic & Bariatric surgery
227 Pol Vaneukem Isppc chu -André Vésale , metabolic & Bariatric surgery
228 Esma Seda Akalın Karaca İstanbul Bilgi University,Turkey,(first author), Department of Pulmonary Medicine, Istanbul Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Zeytinburnu, Turkey(for sekond author)
229 Fatih Can Karaca İstanbul Bilgi University,Turkey,(first author), Department of Pulmonary Medicine, Istanbul Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Zeytinburnu, Turkey(for sekond author)
230 Aziz Sumer Istinye University, School of Medicine, Istanbul,Turkey
231 Caghan Peksen Istinye University, School of Medicine, Istanbul,Turkey
232 Osman Anil Savas Istinye University, School of Medicine, Istanbul,Turkey
233 Elias Chousleb Jackson North Medical Center, Miami Fl
234 fahad Elmokayed king Abdul aziz hospital, Alhasa,saudi arabia
235 islam fakhereldin king Abdul aziz hospital, Alhasa,saudi arabia
236 Hany Mohamed Aboshanab king Abdul aziz hospital, Alhasa,saudi arabia
237 Talal swelium king Abdul aziz hospital, Alhasa,saudi arabia
238 Ahmad Gudal King Abdullah Medical Complex, Jeddah, KSA
239 Lamees Gamloo King Abdullah Medical Complex, Jeddah, KSA
240 Ayushka Ugale Kirloskar Hospital, Hyderabad, India
241 Surendra Ugale Kirloskar Hospital, Hyderabad, India
242 Clara Boeker Klinikum Region Hannover- Klinikum Nordstadt
243 Christian Reetz Klinikum Region Hannover- Klinikum Nordstadt
244 Ibrahim Ali Hakami Klinikum Region Hannover- Klinikum Nordstadt
245 Julian Mall Klinikum Region Hannover- Klinikum Nordstadt
246 Andreas Alexandrou Laiko General Hospital, National and Kapodistrian University of Athens, Greece
247 Efstratia Baili Laiko General Hospital, National and Kapodistrian University of Athens, Greece
248 Zsolt Bodnar Letterkenny University Hospital, Letterkenny, Ireland
249 Almantas Maleckas Lithuanian University of Health Sciences, Surgery Department, Kaunas, Lithuania
250 Rita Gudaityte Lithuanian University of Health Sciences, Surgery Department, Kaunas, Lithuania
251 Cem Emir Guldogan Liv Hospital Ankara, Turkey
252 Emre Gundogdu Liv Hospital Ankara, Turkey
253 Mehmet Mahir Ozmen Liv Hospital Ankara, Turkey (Istinye University School of Medicine)
254 Deepti Thakkar Livlife Hospitals, Hyderabad, India
255 Nandakishore Dukkipati Livlife Hospitals, Hyderabad, India
256 Poonam Shashank Shah LOC Healthcare LLP, Pune, India
257 Shashank Subhashchandra Shah LOC Healthcare LLP, Pune, India
258 Simran Shashank Shah LOC Healthcare LLP, Pune, India
259 Md Tanveer Adil Luton and Dunstable Hospital
260 Periyathambi Jambulingam Luton and Dunstable Hospital
261 Ravikrishna Mamidanna Luton and Dunstable Hospital
262 Douglas Whitelaw Luton and Dunstable University Hospital
263 Md Tanveer Adil Luton and Dunstable University Hospital
264 Vigyan Jain Luton and Dunstable University Hospital
265 Deepa Kizhakke Veetil Manipal Hospital, New Delhi, India
266 Randeep Wadhawan Manipal Hospital, New Delhi, India
267 Antonio Torres Max Medical, centro de cirugía bariátrica/robótica, Hospital Metropilitano de Quito/Ecuador
268 Max Torres Max Medical, centro de cirugía bariátrica/robótica, Hospital Metropilitano de Quito/Ecuador
269 Tabata Tinoco Max Medical, centro de cirugía bariátrica/robótica, Hospital Metropilitano de Quito/Ecuador
270 Wouter Leclercq Máxima Medical Center, Veldhoven, The Netherlands
271 Marleen Romeijn Máxima Medical Center, Veldhoven, The Netherlands
272 Kelly van de Pas Máxima Medical Center, Veldhoven, The Netherlands
273 Ali K. Alkhazraji Mediclinic Hospital Airport Road, Abu Dhabi, UAE.
274 Safwan A. Taha Mediclinic Hospital Airport Road, Abu Dhabi, UAE.
275 Murat Ustun Memorial Hospital, Istanbul, Turkey
276 Taner Yigit Memorial Hospital, Istanbul, Turkey
277 Aatif Inam Metabolic, Thoracic & General Surgery Team III, Department of General Surgery , Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
278 Muhammad Burhanulhaq Metabolic, Thoracic & General Surgery Team III, Department of General Surgery , Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
279 Abdolreza Pazouki Minimally Invasive Surgery Research Center, Division of Minimally invasive and Bariatric surgery, Department of Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
280 Foolad Eghbali Minimally Invasive Surgery Research Center, Division of Minimally invasive and Bariatric surgery, Department of Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
281 Mohammad Kermansaravi Minimally Invasive Surgery Research Center, Division of Minimally invasive and Bariatric surgery, Department of Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
282 Amir Hosein Davarpanah Jazi Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
283 Mohsen Mahmoudieh Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
284 Neda Mogharehabed Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
285 Gregory Tsiotos MITERA Hospital, Athens, Greece
286 Konstantinos Stamou MITERA Hospital, Athens, Greece
287 Francisco J. Barrera Rodriguez Monterrey Gastro & Bariatric Group, Monterrey Mexico
288 Marco A. Rojas Navarro Monterrey Gastro & Bariatric Group, Monterrey Mexico
289 Omar MOhamed Torres Monterrey Gastro & Bariatric Group, Monterrey Mexico
290 Sergio Lopez Martinez Monterrey Gastro & Bariatric Group, Monterrey Mexico
291 Elda Rocio Maltos Tamez MtyBariatrics, Monterrey, Nuevo Leon, Mexico
292 Gustavo A. Millan Cornejo MtyBariatrics, Monterrey, Nuevo Leon, Mexico
293 Jose Eduardo Garcia Flores MtyBariatrics, Monterrey, Nuevo Leon, Mexico
294 Diya Aldeen Mohammed Najjar Hospital,Beirut, Lebanon
295 Mohamad Hayssam Elfawal Najjar Hospital,Beirut, Lebanon
296 Asim Shabbir National University Hospital Singapore
297 Kim Guowei National University Hospital Singapore
298 Jimmy BY So National University Hospital Singapore
299 Elif Tuğçe Kaplan NCR International Hospital, Gaziantep, Turkey
300 Mehmet Kaplan NCR International Hospital, Gaziantep, Turkey
301 Tuğba Kaplan NCR International Hospital, Gaziantep, Turkey
302 DangTuan Pham Niagara Falls Memorial Medical Center, Niagara Falls, NY, USA
303 Gurteshwar Rana Niagara Falls Memorial Medical Center, Niagara Falls, NY, USA
304 Mojdeh Kappus Niagara Falls Memorial Medical Center, Niagara Falls, NY, USA
305 Riddish Gadani NOBESITY BARIATRIC CENTRE, K D HOSPITAL, AHMEDABAD, INDIA
306 Manish Kahitan NOBESITY BARIATRIC CENTRE, K D HOSPITAL, AHMEDABAD, INDIA
307 Koshish Pokharel NOBESITY BARIATRIC CENTRE, K D HOSPITAL, AHMEDABAD, INDIA
308 Alan Osborne North Bristol NHS Trust
309 Dimitri Pournaras North Bristol NHS Trust
310 James Hewes North Bristol NHS Trust
311 Errichetta Napolitano Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
312 Sonja Chiappetta Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
313 Vincenzo Bottino Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
314 evelyn dorado obesity and stethic surgery clinic clinica med cali colombia
315 Axel Schoettler Obesity Center, Municipal Hospital Karlsruhe, Germany
316 Daniel Gaertner Obesity Center, Municipal Hospital Karlsruhe, Germany
317 Katharina Fedtke Obesity Center, Municipal Hospital Karlsruhe, Germany
318 Francisco Aguilar-Espinosa Obesity Clinic: Los Altos Obesity Surgery, Tepatitlan, Mexico
319 Saul Aceves-Lozano Obesity Clinic: Los Altos Obesity Surgery, Tepatitlan, Mexico
320 Alessandro Balani Ospedale di Gorizia, Italy. Struttura Complessa Chirurgia Generale
321 Carlo Nagliati Ospedale di Gorizia, Italy. Struttura Complessa Chirurgia Generale
322 Damiano Pennisi Ospedale di Gorizia, Italy. Struttura Complessa Chirurgia Generale
323 Andrea Rizzi Ospedale Galmarini Tradate, Varese, Italy
324 Francesco Frattini Ospedale Galmarini Tradate, Varese, Italy
325 Diego Foschi Ospedale San Giuseppe IRCCS Multimedica, University of Milan, Milan, Italy
326 Laura Benuzzi Ospedale San Giuseppe IRCCS Multimedica, University of Milan, Milan, Italy
327 CHIRAG PARIKH PARUL INSTITUTE OF MEDICAL SCIENCES & RESEARCH, PARUL UIVERSITY, WAGHODIA, VADODARA, INDIA
328 HARSHIL SHAH PARUL INSTITUTE OF MEDICAL SCIENCES & RESEARCH, PARUL UIVERSITY, WAGHODIA, VADODARA, INDIA
329 Enrico Pinotti Policlinico San Pietro, Bergamo, Italy, Unitá di Chirurgia Bariatrica
330 Mauro Montuori Policlinico San Pietro, Bergamo, Italy, Unitá di Chirurgia Bariatrica
331 Vincenzo Borrelli Policlinico San Pietro, Bergamo, Italy, Unitá di Chirurgia Bariatrica
332 Jerome Dargent Polyclinique Lyon-Nord, 69140 Rillieux, France
333 Catalin A COPAESCU PONDERAS ACADEMIC HOSPITAL, Bucharest, ROMANIA
334 Ionut HUTOPILA PONDERAS ACADEMIC HOSPITAL, Bucharest, ROMANIA
335 Bogdan SMEU PONDERAS ACADEMIC HOSPITAL, Bucharest, ROMANIA
336 Bart Witteman Rijnstate Hospital/Vitalys Clinics, Arnhem, the Netherlands
337 Eric Hazebroek Rijnstate Hospital/Vitalys Clinics, Arnhem, the Netherlands
338 Laura Deden Rijnstate Hospital/Vitalys Clinics, Arnhem, the Netherlands
339 Laura Heusschen Rijnstate Hospital/Vitalys Clinics, Arnhem, the Netherlands
340 Sietske Okkema Rijnstate Hospital/Vitalys Clinics, Arnhem, the Netherlands
341 Theo Aufenacker Rijnstate Hospital/Vitalys Clinics, Arnhem, the Netherlands
342 Willem den Hengst Rijnstate Hospital/Vitalys Clinics, Arnhem, the Netherlands
343 Wouter Vening Rijnstate Hospital/Vitalys Clinics, Arnhem, the Netherlands
344 Yonta van der Burgh Rijnstate Hospital/Vitalys Clinics, Arnhem, the Netherlands
345 Ahmad Ghazal Saint Louis Hospital - Aleppo,Syria
346 Hamza Ibrahim Saint Louis Hospital - Aleppo,Syria
347 Mourad Niazi Saint Louis Hospital - Aleppo,Syria
348 Bilal Alkhaffaf Salford Royal NHS Foundation Trust
349 Mohammad Altarawni Salford Royal NHS Foundation Trust
350 Giovanni Carlo Cesana San Marco Hospital GSD, Zingonia (BG), Italy
351 Marco Anselmino San Marco Hospital GSD, Zingonia (BG), Italy
352 Matteo Uccelli San Marco Hospital GSD, Zingonia (BG), Italy
353 Stefano Olmi San Marco Hospital GSD, Zingonia (BG), Italy
354 Christine Stier Sana Obesity Center Northrhine Westphalia, Clinic for General, Visceral, and Transplantation Surgery,
355 Tahsin Akmanlar Sana Obesity Center Northrhine Westphalia, Clinic for General, Visceral, and Transplantation Surgery,
356 Thomas Sonnenberg Sana Obesity Center Northrhine Westphalia
357 Uwe Schieferbein Sana Obesity Center Northrhine Westphalia
358 Alejandro Marcolini Sanatorio Britanico de Rosario, Rosario, Santa Fe, Argentina
359 Diego Awruch Sanatorio Britanico de Rosario, Rosario, Santa Fe, Argentina
360 Marco Vicentin Sanatorio Britanico de Rosario, Rosario, Santa Fe, Argentina
361 Eduardo Lemos de Souza Bastos Santa Casa de Marilia, Marilia, Brazil
362 Samuel Azenha Gregorio Santa Casa de Marilia, Marilia, Brazil
363 Anmol ahuja sir ganga ram hospital delhi india
364 Tarun mittal sir ganga ram hospital delhi india
365 Roel Bolckmans Somerset NHS Foundation Trust
366 Tom Wiggins Somerset NHS Foundation Trust
367 Clément Baratte Sorbonne Université, Institute of Cardiometabolism and Nutrition ICAN, Assistance Publique-Hôpitaux de Paris, Departments of Digestive surgery and Nutrition, Pitié-Salpêtrière University Hospital, Paris, France.
368 Judith Aron Wisnewsky Sorbonne Université, Institute of Cardiometabolism and Nutrition ICAN, Assistance Publique-Hôpitaux de Paris, Departments of Digestive surgery and Nutrition, Pitié-Salpêtrière University Hospital, Paris, France.
369 Laurent Genser Sorbonne Université, Institute of Cardiometabolism and Nutrition ICAN, Assistance Publique-Hôpitaux de Paris, Departments of Digestive surgery and Nutrition, Pitié-Salpêtrière University Hospital, Paris, France.
370 Lynn Chong St Vincent's Hospital Melbourne
371 Lillian Taylor St Vincent's Hospital Melbourne
372 Salena Ward St Vincent's Hospital Melbourne
373 Lynn Chong St Vincent's Hospital, Melbourne, Australia
374 Lillian Taylor St Vincent's Hospital, Melbourne, Australia
375 Michael W Hi St Vincent's Hospital, Melbourne, Australia
376 Helen Heneghan St Vincent's University Hospital, Dublin, Ireland
377 Naomi Fearon St Vincent's University Hospital, Dublin, Ireland
378 Andreas Plamper St. Franziskus Hospital, Cologne, Germany
379 Karl Rheinwalt St. Franziskus Hospital, Cologne, Germany
380 Helen Heneghan St. Vincent's University Hospital, Dublin, Ireland
381 Justin Geoghegan St. Vincent's University Hospital, Dublin, Ireland
382 Kin Cheung Ng St. Vincent's University Hospital, Dublin, Ireland
383 Naomi Fearon St. Vincent's University Hospital, Dublin, Ireland
384 Krzysztof Kaseja State Clinical Hospital No 2 of the Pomeranian Medical University in Szczecin, Poland
385 Maciej Kotowski State Clinical Hospital No 2 of the Pomeranian Medical University in Szczecin, Poland
386 Tarig A Samarkandy Sutter Gould Medical Foundation, Dameron Hospital - Ca, USA
387 Adolfo Leyva-Alvizo Tecnologico de Monterrey, Monterrey, MX
388 Lourdes Corzo-Culebro Tecnologico de Monterrey, Monterrey, MX
389 Cunchuan Wang The First Affiliated Hospital of Jinan University, Guangzhou, China
390 Wah Yang The First Affiliated Hospital of Jinan University, Guangzhou, China
391 Zhiyong Dong The First Affiliated Hospital of Jinan University, Guangzhou, China
392 Manel Riera The Shrewsbury and Telford Hospital, Shrewsbury, UK
393 Rajesh Jain The Shrewsbury and Telford Hospital, Shrewsbury, UK
394 Hosam Hamed Truelife bariatric and digestive surgery center, Mansoura, Dakahleyya, Egypt
395 Truelife bariatric and digestive surgery center, Mansoura, Dakahleyya, Egypt
396 Katia Zarzar Tu Opcion Bariatrica
397 Manuel Garcia Tu Opcion Bariatrica
398 Ahmet Gökhan Türkçapar Türkçapar Bariatrics Obesity Center, İstanbul, Turkey
399 Ozan Şen Türkçapar Bariatrics Obesity Center, İstanbul, Turkey
400 Edoardo Baldini U.O. Chirurgia, Ospedale "Guglielmo da Saliceto", Piacenza, Italy
401 Luigi Conti U.O. Chirurgia, Ospedale "Guglielmo da Saliceto", Piacenza, Italy
402 Cacio Wietzycoski Unimed Vale do Caí Hospital, Montenegro, BR. Maicé Hospital, Caçador, BR
403 Eduardo Lopes Unimed Vale do Caí Hospital, Montenegro, BR. Maicé Hospital, Caçador, BR
404 Tadeja Pintar University Medical Center Ljubljana, Slovenia
405 Jure Salobir University Medical Center Ljubljana, Slovenia
406 Cengiz Aydin University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
407 Semra Demirli Atici University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
408 Anıl Ergin University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, General Surgery Department, Istanbul, Turkey
409 Huseyin Ciyiltepe University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, General Surgery Department, Istanbul, Turkey
410 Mehmet Abdussamet Bozkurt University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
411 Mehmet Celal Kizilkaya University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
412 Nezihe Berrin Dodur Onalan University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
413 Mariana Nabila Binti Ahmad Zuber University of Malaya Medical Centre, Kuala Lumpur, Malaysia
414 Wei Jin Wong University of Malaya Medical Centre, Kuala Lumpur, Malaysia
415 Amador Garcia Vall d'Hebron University Hospital, Barcelona, Spain
416 Laura Vidal Vall d'Hebron University Hospital, Barcelona, Spain
417 Marc Beisani Vall d'Hebron University Hospital, Barcelona, Spain
418 Jorge Pasquier Vall Hebron Hospital Campus - Hospital de Barcelonoa-SCIAS
419 Ramon Vilallonga Vall Hebron Hospital Campus - Hospital de Barcelonoa-SCIAS
420 Sharad Sharma Vinamra Swaraj Hospital, Navi Mumbai, India
421 Chetan Parmar Whittington Health NHS Trust, London, United Kingdom
422 Lyndcie Lee Whittington Health NHS Trust, London, United Kingdom
423 Pratik Sufi Whittington Health NHS Trust, London, United Kingdom
424 Hüseyin Sinan www.metabolistsurgery.com Istanbul Turkey
425 Mehmet Saydam www.metabolistsurgery.com Istanbul Turkey
Funding
The study was funded by the bariatric unit’s research funds at University Hospitals Birmingham NHS Foundation Trust (Birmingham, UK).
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This project was registered as a multinational audit (number: 5197) at the University Hospitals Birmingham NHS Foundation Trust, UK. Each site project lead was responsible for obtaining local governance approvals and data sharing agreements before entering data into the registry.
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No informed consent was needed for an audit of this nature.
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KM has been paid honoraria by various NHS trusts and Ethicon®, Medtronic®, Gore Inc®, and Olympus® for educational activities related to bariatric surgery. Other authors have no conflicts of interest.
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Key Points
• This study compared the safety of bariatric surgery in patients ≥ 65 years of age with those < 65 years of age during the COVID-19 pandemic.
• The 30-day morbidity was higher in those ≥ 65 years of age.
• The 30-day mortality and postoperative symptomatic COVID-19 infection rates were not significantly different between the two groups.
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Singhal, R., Omar, I., Madhok, B. et al. Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic. OBES SURG 32, 1–13 (2022). https://doi.org/10.1007/s11695-022-06067-z
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DOI: https://doi.org/10.1007/s11695-022-06067-z