The patches and hotfixes are not included in the Backup / Restore process.
This will allow for the ability to roll back a hotfix by reverting to a prior snapshot and then restoring a backup.
As full database backups are included in backups, any hotfix that only makes changes to database code are not required after a restore. Any hotfix that makes a registry or other OS level adjustment would not be captured in a backup.
Hotfixes that make OS or Registry level changes will not be included in a backup.
When restoring to a new (or reverted to a prior snapshot) appliance, any required Hotfixes not included in the target appliance release version should be applied to the new appliance.