Background

The COVID-19 pandemic has profoundly impacted healthcare systems worldwide. Revisional bariatric surgery, as an essential treatment for weight recurrence and complications after bariatric, may have been significantly affected. This study aims to evaluate the pandemic's effect on revisional bariatric surgery procedures and trends by utilizing the MBSAQIP database to compare the pandemic, vaccination rollout, and post-pandemic periods.

Methods

We conducted a retrospective analysis of revisional, and conversional bariatric surgeries recorded in the MBSAQIP database from 2020 (during the pandemic), 2021 (vaccination rollout), and 2022 (post-pandemic). The number of cases, indications, complications, and procedures for revision and conversion were compared.

Results

Out of 609,240 patients, 55,854 underwent conversion, and 16,335 underwent revision during 2020-2022. The percentage of conversions and revisions remained relatively constant (12.1%, 12.1%, 11.5%, p<0.001), but urgent revision rates were higher during the pandemic (3.1%, 2.2%, 1.8%, p<0.001). During the pandemic, revisional cases focused more on managing severe complications such as gastrointestinal fistula, perforation, stricture and dysphagia. However, after the pandemic, these shifted towards addressing weight recurrence, inadequate weight loss, and reflux. With this trend, the number of sleeve-to-bypass and sleeve-to-duodenal-switch procedures increased significantly after the pandemic (Table 1). For revisions and conversions, serious complications were highest in 2020 (6.6%) and 2021 (6.4%) but lower in the post-pandemic period (5.8%, p<0.001). However, mortality was unchanged throughout the study (0.15%).

Conclusions

Our study demonstrates distinct trends throughout the pandemic periods. This also shows that procedures during the pandemic were safe and necessary, although complications rates were slightly higher