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Bariatric surgery linked to increased mortality risk in cirrhosis

SAN FRANCISCO — Individuals with decompensated cirrhosis who underwent bariatric surgery experienced poorer survival outcomes than those with compensated cirrhosis and individuals who did not undergo this surgery, according to data presented at The Liver Meeting 2018.

Connor Griffin , MD, of Baylor University Medical Center, suggested that bariatric surgery is associated with poor short-term outcomes and increased mortality among patients with cirrhosis.

“Cirrhotic patients are in a catabolic state and thus at higher risk for malnutrition,” he said. “In our study, we aimed to examine the mortality in cirrhotics with and without bariatric surgery, and, more specifically, to examine mortality in patients with decompensated cirrhosis.”

The study included 60,543 patients from 84 hospitals in the Dallas-Ft. Worth area between 2000 and 2015 who were followed for 5 years.

“We included all patients who presented with liver disease,” he said. “We evaluated overall mortality, we evaluated mortality in compensated vs. decompensated cirrhosis, we evaluated the impact of gender, and we evaluated the impact of etiology.”

Background on the cohort showed that hepatic encephalopathy was the most common cause of decompensation in the bariatric surgery group, according to Griffin. He added that patients with cirrhosis who underwent bariatric surgery were more likely to be women (73% vs. 38%) and have nonalcoholic steatohepatitis (16.1% vs. 3.2%). Alcoholic cirrhosis rates were comparable among patients with cirrhosis who did and did not undergo bariatric surgery, as were decompensation rates.

Results indicated higher mortality rates in patients with cirrhosis who underwent bariatric surgery compared with those who did not undergo the surgery (P = .04).

Among patients with compensated and decompensated cirrhosis who did or did not undergo bariatric surgery, the poorest survival was reported among patients with decompensated cirrhosis who underwent the procedure (P < .001), according to the findings.

Patients with compensated cirrhosis who underwent bariatric surgery had similar survival to those with decompensated cirrhosis who did not receive bariatric surgery.

“Bariatric surgery plus compensated cirrhosis had similar survival to compensated cirrhotics when they started out, but at about 2 years, they started to mirror decompensated cirrhotics,” Griffin said. “At 5 years, bariatric surgery plus compensated cirrhosis was similar to decompensated cirrhosis, in terms of survival.”

Patients with decompensated cirrhosis who underwent bariatric surgery also had the highest multiple hospitalization rates within 1 year of presentation, at 23% (P < .001). Multiple hospitalizations occurred in 17% of patients with compensated cirrhosis who underwent surgery, 9% of patients with compensated cirrhosis who did not undergo surgery, and 14% of patients with decompensated cirrhosis who did not undergo surgery, according to Griffin. “You can see that the patients with bariatric surgery were much more likely to have two or more hospitalizations that those who were not,” he said.

Looking at sex, women with cirrhosis who underwent bariatric surgery had the poorest survival curve compared with all men, and women with cirrhosis who did not undergo surgery (P = .039).

In terms of the effect of etiology on mortality, there was no difference in survival between nonalcoholic fatty liver disease and alcohol among patients undergoing surgery (P = .81).

Multivariate analysis results showed that age predicted mortality, according to Griffin. “As expected, the older patients got, the higher risk they were for mortality,” he said.

Bariatric surgery also carried an independent mortality risk after adjusting for age and decompensation status (HR = 1.3; P = .002).

“Bariatric surgery was independently associated with lower survival among cirrhotics even after adjustment of age and decompensation,” Griffin concluded. “Patients undergoing bariatric surgery evaluation may benefit from cirrhosis screening.” – by Rob Volansky

Reference:

Griffin C, et al. Abstract 218. Presented at: The Liver Meeting 2018; Nov. 9-13, 2018; San Francisco.

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Disclosure: Griffin reports no relevant financial disclosures.