- 1Liver Center, Division of Gastroenterology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
Objectives: : Since there is increasingly higher number of patients with cirrhosis who require the bariatric procedure due to obesity and obesity-related nonalcoholic steatohepatitis (NASH) fibrosis, we evaluate the effect of cirrhosis on post-bariatric surgery outcomes using propensity-score matched analysis.
Methods: : 2011-2017 National Inpatient Sample was used to isolate bariatric cases, which were stratified by cirrhosis; controls were propensity-score matched to cases and compared to endpoints: mortality, length of stay (LOS), costs, and postoperative complications.
Results: : From 190753 patients undergoing bariatric surgery, there were 957 with cirrhosis and 957 matched controls. In comparison, there was no difference in mortality (0.94 vs 0.52% p=0.42, OR 1.81 95%CI 0.60-5.41); however, cirrhosis patients had higher LOS (3.36 vs 2.89d p=0.002), costs ($68671 vs $61301 p<0.001), and postoperative bleeding (2.09 vs 0.72% p<0.001, OR 2.95 95%CI 1.89-4.61). In multivariate, there was no difference in mortality (p=0.330, aOR 1.73 95%CI 0.58-5.19). In subgroup comparison of cirrhosis patients, those with decompensated cirrhosis had higher mortality (7.69 vs 0.94% p<0.001, OR 8.78 95%CI 3.41-22.59).
Conclusion: : The results of this study show compensated cirrhosis does not pose an increased risk toward post-bariatric surgery mortality; however, hepatic decompensation increases the postsurgical risks.