David U. Lee, MD, Gregory H. Fan, BA, Raffi Karagozian, MD; Tufts Medical Center, Boston, MA
Introduction: Bariatric surgery is offered to patients with morbid obesity and nonalcoholic steatohepatitis (NASH) as a standard of care procedure. However, a proportion of these patients have underlying cirrhosis and are therefore at an increased risk of postoperative complications following bariatric surgery due to cirrhosis-related comorbidities. Methods: Patients who underwent bariatric procedures (gastric sleeve, open and laparoscopic gastric bypass, and other restrictive gastric procedures) were selected from the 2011-2017 National Inpatient Sample and were stratified by the presence of cirrhosis. The study endpoints included mortality, length of stay (LOS), hospitalization costs, and postprocedural complications. Results: Of the 191749 bariatric surgery patients identified from the database, 1109 of these patients also had cirrhosis. The cirrhosis patients were older (55 vs 45.4y p< 0.01) and were more likely to be male (33.1 vs 22.0% p< 0.01). Mortality was higher among the cirrhosis patients (1.62 vs 0.23% p< 0.01, OR 7.21 95%CI 4.49-11.6), as were LOS (4.02 vs 2.47d p< 0.01) and total hospitalization costs ($81,301 vs $56,015 p< 0.01). The cirrhosis patients had lower incidences of obesity (87.4 vs 95.8% p< 0.01, OR 0.30 95%CI 0.25-0.36) and morbid obesity (84.9 vs 94.6% p< 0.01, OR 0.32 95%CI 0.27-0.38). However, the cirrhosis patients had higher incidences of postoperative bleeding (2.52 vs 0.70% p< 0.01, OR 3.65 95%CI 2.50-5.33) and wound complications (0.63 vs 0.14% p< 0.01, OR 4.51 95%CI 2.13-9.58). No differences between cohorts were found in the incidences of bowel perforation (0.36 vs 0.14% p=0.07, OR 2.62 95%CI 0.71-6.81), bowel obstruction (0.81 vs 0.61% p=0.5, OR 1.34 95%CI 0.69-2.59), and postoperative infection (0.18 vs 0.11% p=0.33 OR 1.69 95%CI 0.20-6.22). In a multivariate model that included cirrhosis and hepatic events, hepatic encephalopathy (p< 0.01, aOR 7.76 95%CI 1.97-25.9), ascites (p=0.01, aOR 1.60 95%CI 1.09-2.32), and hepatorenal syndrome (p=0.02, aOR 8.68 95%CI 1.44-55.6) were associated with postprocedural mortality. Discussion: Cirrhosis-related complications, including hepatic encephalopathy, ascites, and hepatorenal syndrome, are associated with increased postoperative mortality in bariatric surgery patients. These patients therefore require early risk-assessment and multidisciplinary management of cirrhosis-related complications in order to optimize postoperative outcomes.
Multivariate model: hepatic encephalopathy, ascites, and hepatorenal syndrome are associated with postprocedural mortality in patients undergoing bariatric procedures
Disclosures: David Lee indicated no relevant financial relationships. Gregory Fan indicated no relevant financial relationships. Raffi Karagozian indicated no relevant financial relationships.