Bariatric surgery safe in compensated cirrhosis

WASHINGTON, D.C. — Patients with nonalcoholic fatty liver disease and compensated cirrhosis who underwent bariatric surgery did not have higher rates of in-hospital mortality compared with patients without cirrhosis who underwent the procedure, according to a study presented at Digestive Disease Week 2018.

“Obesity is associated with NAFLD, which in 20% to 40% of cases leads to cirrhosis,” Abdulfatah Issak, MD, from the Ohio State University, said in his presentation. “There are many behavioral, medical and surgical approaches to the treatment of weight loss for morbid obesity. However, bariatric surgery is the most effective weight loss strategy, and in the U.S. its use has increased from 160,000 cases per year in 2011 to 200,000 cases per year in 2016.”

Issak and colleagues gathered patient data from the National Inpatient Sample from 2008 to 2013 to evaluate recent outcomes of bariatric surgery in patients with cirrhosis. The study comprised 558,017 patients who had no cirrhosis, compensated cirrhosis (n = 3,189), or decompensated cirrhosis (n = 103).

Among patients without cirrhosis, the researchers found a significant increase in the rate of bariatric surgery during the study period. While not significant, there was a trend of increased bariatric surgery among patients with compensated or decompensated cirrhosis, especially in 2012 and 2013.

In all three groups, the trend of mortality after bariatric surgery remained stable during the study period.

Compared with patients with no cirrhosis, multivariate analysis showed that patients with compensated cirrhosis had a significantly longer length of hospital stay (OR = 1.03; 95% CI, 1-1.06) and higher total cost (OR = 1.06; 95% CI, 1.02-1.1), but the difference in mortality was not significant.

Patients with decompensated cirrhosis compared with those with no cirrhosis, however, had significantly longer hospital stay (OR = 1.76; 95% CI, 1.34-2.31), higher total cost (OR = 1.97; 95% CI, 1.74-2.64), and higher mortality rates (OR = 98; 95% CI, 28.7-334.3). Final analysis showed that decompensated cirrhosis was a significant predictor of in-hospital mortality.

“Bariatric surgery is associated with increased in-hospital mortality in compensated cirrhosis in the latest era. However, bariatric cirrhosis carries higher mortality in patients with decompensated cirrhosis,” Issak concluded. “Careful selection of patients, procedure and size of surgical center is integral in improving outcomes and health care utilization in patient with cirrhosis undergoing bariatric surgery.” – by Talitha Bennett

For more information:

Issak A, et al. Abstract 3. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosure: Issak reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.