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Medical complications Descriptions Malnutrition44 Albumin < 35 gm/L and/or total protein < 66 gm/L ± one or more of: magnesium < 0.7 mmol/L, calcium < 2.1 mmol/L, phosphorus < 0.74 mmol/L, potassium < 3.5 mmol/L, iron < 9 umol/L, vitamin B1 < 66.08 nmol/L, vitamin B6 < 20 nmol/L, folate (B9) < 10 nmol/L, vitamin B12 < 145 pmol/L, vitamin D < 30 umol/L, vitamin A < 1 umol/L, vitamin K < 0.2 ng/mL, copper < 12.6 umol/L, zinc < 10 umol/L, selenium < 70 ng/mL Neuromuscular*45 Abnormal findings of either: MRI (for central lesions) or nerve conduction study (NCS) and/or electro myelography (EMG) (for peripheral lesions) undertaken as in/outpatient *Diagnosed by neurologists and clinical neurophysiologists based on clinical, laboratory, and electrodiagnostic findings
- Table 2
- Characteristics of bariatric patients admitted with medical complications after surgery before and during the pandemic (n=48)
Parameters Total
N=48COVID-19 P-value Before
n=12During
n=36Demographic Age, years (M±SD) 26.62±10.76 28.50±11.28 26±10.67 0.492 Range 16-62 18-51 16-62 Gender, female, n (%) 26 (54.2) 4 (33.3) 22 (61.1) 0.94 Anthropometric (M±SD) Weight before BMS (kg) 123.04±21.37 128.09±24.67 121.50±20.40 0.377 BMI before BMS (kg/m2) 44.41±5.37 45.88±5.54 43.96±5.31 0.305 Weight at admission with MC (kg) 85.02±19.37 87±26.34 84.41±17.12 0.900 BMI at admission with MC (kg/m2) 30.70±5.61 30.95±7.34 30.63±5.64 0.880 Weight loss (kg) 38.02±14.40 41.09±13.87 37.08±14.62 0.426 Surgery Type, n (%) Sleeve gastrectomy 46 (95.8) 11 (91.7) 35 (97.2) 0.404 Gastric bypass 2 (4.2) 1 (8.3) 1 (2.8) Duration from surgery a, m 0.738 Median 3 3 4 Range 1-12 1-12 1-12 Outcomes, n (%) Rehabilitationb 27 (56.3) 9 (33.3) 18 (66.7) 0.131 LOS during admission with MC, days 0.277 Median 14 15 8 Range 3-79 3-78 3-79 Admission rate Total number of BMS 4534 4208 326 Total number of admissions due to MC 48 12 36 <0.0001 Admission rate per 100 BMS c 1.06 0.29 11.04 <0.0001 BMS - bariatric and metabolic surgery, LOS - length of hospital stay, m - months, MC - medical complications.
- Table 3
- Neuromuscular and malnutrition characteristics of medical complications of admitted patients
Medical Complications Total COVID-19 P-value Before
n=12During
n=36Neuromuscular Investigation* Not Done 20 (41.7) 6 (50) 14 (38.9) 0.499 Normal 4 (8.3) 1 (8.3) 3 (8.3) 1.0 Abnormal Peripheral Motor Axonal 2 (4.2) 0 (0) 2 (5.6) 0.404 Sensory Axonal 6 (12.5) 2 (16.7) 4 (11.1) 0.614 Sensory Motor Axonal 13 (27.1) 3 (25) 10 (27.8) 0.851 Sensory Peripheral Neuropathy 2 (4.2) 0 (0) 2 (5.6) 0.404 Central Werneck Encephalopathy 1 (2.1) 0 (0) 1 (2.8) 0.560 Malnutrition Protein-related Albumin 26 (54.2) 8 (30.8) 18 (69.2) 0.316 Protein 14 (29.2) 5 (35.7) 9 (64.3) 0.271 Micronutrient deficiency Minerals Magnesium 8 (19) 1 (12.5) 7 (87.5) 0.494 Calcium 1 (2.1) 0 (0) 1(100) 0.560 Phosphorus 3 (7.9) 0 (0) 3 (100) 0.315 Potassium 17 (35.4) 4(23.5) 13 (76.5) 0.862 Iron 8 (21.1) 3 (37.5) 5 (62.5) 0.419 Vitamins A 16 (66.7) 3 (18.8) 13 (81.3) 0.722 B1 8 (19) 0 (0) 8 (100) 0.127 B6 3 (11.1) 0 (0) 3 (100) 0.719 B9 (Folic acid) 10 (35.7) 6 (60) 4 (40) 0.046 B12 1 (2.1) 1 (100) 0 (0) 0.084 D 35 (79.5) 9 (25.7) 26 (74.3) 0.829 K 7 (41.2) 1 (14.3) 6 (85.7) 0.761 Trace elements Copper 7 (15.2) 1 (14.3) 6 (85.7) 0.604 Zinc 9 (19.6) 4 (44.4) 5 (55.6) 0.066 Selenium 8 (38.1) 3 (37.5) 5 (62.5) 0.965 Cells represent frequency and percentage n (%) based on the total sample as denominator. *Comprises nerve conduction study, electromyelography or magnetic resonance imaging. Nerve conduction studies/electromyography data was available for 26 of the 48 patients. Italicised cells indicate statistical significance. Reference values for malnutrition or deficiency: albumin 35-50 gm/L, total protein <66 gm/L, vitamin B1<66.08 nmol/L, vitamin B6 <20 nmol/L, vitamin B12 <145 pmol/L, vitamin D <30 umol/L, copper <12.6 umol/L, folate <10 nmol/L, zinc <10 umol/L, iron <9 umol/L, TIBC (total iron binding capacity) <45 umol/L, potassium <3.5 mmol/L, calcium <2.1 mmol/L, phosphorus <0.74 mmol/L, magnesium <0.7 mmol/L.
- Table 4
- Characteristics common among bariatric patients admitted with medical complications.
Factors Total
N=48COVID-19 P-value Before
n=12During
n=36Clinical Post-BMS nausea 32 (66.7) 8 (66.7) 24 (66.7) 1 Post-BMS vomiting 30 (62.6) 7 (58.3) 23 (63.9) 0.731 Multivitamin non-compliant 42 (87.5) 12 (100) 30 (83.3) 0.131 EWL% (M±SD) 74.19±27.84 75.12±26.81 73.91±28.52 0.901 Barium Meal Not Done 8 (16.7) 1 (8.3) 7 (19.4) 0.371 Normal 19 (39.6) 10 (83.3) 9 (25) <0.0001 Anastomotic ulcer 1 (2.1) 0 (0) 1(2.8) 0.560 Gastritis 2 (4.2) 0 (0) 2 (5.6) 0.404 GERD 18 (37.5) 1 (8.3) 17 (47.2) 0.016 Number of clinic visits after surgery 0.247 0 41 (85.4) 9 (75) 32 (88.9) 1 5 (10.4) 2 (16.7) 3 (8.3) 2 1 (2.1) 0 (0) 1 (2.8) 3 1 (2.1) 1 (8.3) 0 (0) All cells represent frequency and percentage n (%) based on the column header as denominator, except where indicated. BMS - bariatric and metabolic surgery, GERD - gastroesophageal reflux disease, EWL% - excess weight loss percentage. Italicised cells indicate statistical significance
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