Effect of COVID-19 pandemic on hospital admission rates of patients with malnutrition and/or neuromuscular complications after bariatric surgery

Abstract

Objectives: To assess and compare the admission rates of medical complications (MC) after Bariatric and metabolic surgery (BMS) over a period of 6 years prior to and during the pandemic. Bariatric and metabolic surgery could be associated with MC, including malnutrition and neuromuscular complications (NC). Methods: Retrospective study of all patients admitted to Hamad General Hospital, Qatar, with post-BMS MC before (n=12, January 2014-December 2019) and  during  the  pandemic  (n=36, January 2020-31 May 2021). We assessed 17 nutrients, nerve conduction/electromyography diagnosed NC, and we explored whether patients had clustering of gastrointestinal symptoms, barium meal findings, excess weight loss percentage (EWL%), or non-compliance with post-BMS clinic visits and multivitamin supplements. Results: The sample comprised 95.8% sleeve gastrectomies, mean age was 26.62 years, and 54.2% were women. Admissions increased from pre-pandemic 0.29 per 100 BMS to 11.04 during the pandemic (p<0.0001), despite no significant differences in patients' demographic/surgical profiles, nutrient deficiencies, or MC characteristics. Across the sample, the most frequent neuropathies were mixed sensory/motor/axonal; albumin and total protein deficiencies were observed in 54.2% and 29.2% of patients, respectively (no pre-pandemic/ pandemic differences). Most frequent micronutrient and trace element deficiencies were potassium, vitamin D, and zinc (no pre-pandemic/pandemic differences). Admitted patients had high non-compliance with multivitamins supplementation (87.5%), high post-BMS nausea/vomiting (66.7%, 62.6%, respectively), high EWL% (mean=74.19±27.84%), no post-BMS outpatient follow up (75% during pre-pandemic, 88.9% during pandemic) (no pre-pandemic/pandemic differences for all), and gastroesophageal reflux (higher during the pandemic, p=0.016). Conclusion: Despite the reduced number of BMS during the pandemic, hospital admissions of MC significantly increased.