Review Reports

Round 1

Reviewer 1 Report

This is a high-quality paper dealing with a topic (i.e. managing of bariatric surgery before and after 2020 pandemic) that has clear and evident implications for all professionals involved in the managing of this surgical sub-speciality.

Both data reporting and analysis are performed in a very transparent and robust way, and the discussion section is well designed.

Honestly, I've neither requests for further improvements or adjustments to request, and I'm therefore advocating the acceptance of this study in the current stage of development.

Author Response

Thank you for taking the time to review our manuscript and for the positive review. We look forward to seeing this study in print in the near future. 

Reviewer 2 Report

The authors present the outcomes from a MBSAQIP database analysis with the aim of evaluating differences and trends to bariatric surgery care and outcomes between 2020 and 2021 that could have been a result of the COVID 19 pandemic.

The title reflects the subject of the manuscript. It presents a clear and clinically useful message. It is well written in terms of clarity, style, and use of English language. Results are clearly written and figures adequately illustrative. The discussion section is sufficiently detailed and explains adequately the purpose of this study in the context of published information. The conclusion accurately and clearly explains the main result. The length of the manuscript is ideal. All references are appropriate and current.

Author Response

Thank you for your time spent reviewing this manuscript and for your overall positive review. 

Reviewer 3 Report

An interesting study, with many centers, based on a significant statistic.
All elective surgical procedures, such as bariatric surgery, have experienced a decline during the Covid period.
I would suggest a useful analysis of the evolution, also related to the costs of the procedure. An analysis of medical tourism data would also be useful, if this phenomenon has been noted (dumping prices in Turkey), and if there is data on this phenomenon.
Another limitation of the study is the selection of centers from a single geographical area.
It would be useful to mention the phenomenon of burnout registered by the medical staff during the Covid period and to analyze whether this phenomenon also influenced bariatric interventions.
I appreciate that, for a work of this magnitude, the number of references is insufficient and could be improved.

 

Author Response

An interesting study, with many centers, based on a significant statistic. All elective surgical procedures, such as bariatric surgery, have experienced a decline during the Covid period.

Response: Thank you for your review and thoughtful comments. As detailed below, we have made all requested changes or incorporated these comments into the limitations of this study and hope that these have answered any questions you may have. 

I would suggest a useful analysis of the evolution, also related to the costs of the procedure. An analysis of medical tourism data would also be useful, if this phenomenon has been noted (dumping prices in Turkey), and if there is data on this phenomenon.

Response: This is a very interesting point and something we have now discussed in the manuscript, both within the discussion and limitations. Unfortunately, the MBSAQIP does not collect cost data. However, we have added an entire paragraph as the third paragraph in the discussion outlining the points you have made. First, we have discussed how medical tourism may have been reduced immediately during COVID-19 lock downs, but may be increasing since then and that studies are needed to evaluate this. Additionally, we have discussed how these changes may have affected pricing both domestically and internationally, yet remains to be well studied. 

Another limitation of the study is the selection of centers from a single geographical area.

Response: this is a fair point as the MBSAQIP collects data from North America (Canada and the United States) only and we have highlighted this in the limitations of this study. 

It would be useful to mention the phenomenon of burnout registered by the medical staff during the Covid period and to analyze whether this phenomenon also influenced bariatric interventions.

Response: This is a great point that has also now been discussed in the third paragraph of our manuscript's discussion. Thank you for bringing this up.

I appreciate that, for a work of this magnitude, the number of references is insufficient and could be improved.

Response: This is a fair point and we have gone through the manuscript to add additional relevant citations throughout in order to better reference this work. 

Reviewer 4 Report

This is a well written report on how COVID19 impacted on bariatric surgery delivery in North America, based on MBSAQIP database.

No further comment

Author Response

Thank you for the time spent reviewing this manuscript and for you positive review.