Evaluating the impact of the COVID-19 pandemic on outcomes of conversion and revisional bariatric surgery: a Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) study

Mélissa V Wills; Komol Chaivanijchaya; Juan S Barajas-Gamboa; Gabriela Restrepo-Rodas; Valentin Mocanu; Ayan Farah; Sol Lee; Salvador Navarrete; John Rodriguez; Matthew Allemang; Ricard Corcelles; Matthew Kroh; Andrew T Strong; Jerry Dang

doi:10.1016/j.soard.2025.03.004

Evaluating the impact of the COVID-19 pandemic on outcomes of conversion and revisional bariatric surgery: a Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) study

Surg Obes Relat Dis. 2025 Mar 14:S1550-7289(25)00111-X. doi: 10.1016/j.soard.2025.03.004. Online ahead of print.

Affiliations

¹ Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
² Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
³ Department of General Surgery, Seoul Medical Center, Seoul, Republic of Korea.
⁴ Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. Electronic address: dangj3@ccf.org.

PMID: 40234141
DOI: 10.1016/j.soard.2025.03.004

Abstract

Background: The COVID-19 pandemic significantly impacted healthcare delivery worldwide, including bariatric surgery. While revisional procedures remained essential for weight recurrence and complications, practice patterns evolved during different phases of the pandemic.

Objectives: To evaluate the effect of COVID-19 on revisional bariatric procedures by comparing trends across pandemic (2020), vaccination rollout (2021), and postpandemic (2022) periods.

Setting: Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, United States.

Methods: Retrospective analysis of 72,189 bariatric surgeries (of which 55,854 conversions and 16,335 revisions) from 2020 to 2022. Outcomes included surgical volume, indications, complications, and mortality.

Results: Of 609,240 bariatric procedures, 72,189 (11.8%) were revisional or conversion procedures, with conversions representing 9.2% (55,854) and revisions 2.7% (16,335). The combined proportion remained stable (12.1%, 12.1%, 11.5%, P < .001), but urgent revision rates were higher during the pandemic (3.1% versus 2.2% versus 1.8%, P < .001). Pandemic-era cases focused on severe complications (fistula, perforation, stricture), shifting postpandemic toward weight recurrence and reflux. Sleeve-to-bypass conversions increased from 41.2% to 53.6%. Serious complications were highest in 2020-2021 (6.6%, 6.4%) compared to 2022 (5.8%, P < .001), while mortality remained unchanged (.15%).

Conclusions: The study demonstrates distinct trends throughout pandemic periods, reflecting Centers for Disease Control and Prevention guidance on surgical urgency . While complication rates were slightly higher during the pandemic, procedures remained safe with stable mortality. Postpandemic shifts toward elective indications and increasing conversion procedures suggest adaptation to accumulated surgical needs.

Keywords: Bariatric surgery; COVID-19; Healthcare access; MBSAQIP database; Revisional bariatric surgery; Surgical trends.