Bariatric Surgery in Patients with Cirrhosis: Careful Patient and Surgery-Type Selection Is Key to Improving Outcomes
- 1 September 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Obesity Surgery
- Vol. 30 (9), 3444-3452
- https://doi.org/10.1007/s11695-020-04583-4
Abstract
Purpose Previous reports suggest an increased mortality in cirrhotic patients undergoing bariatric surgery (BS). With advancements in management of BS, we aim to study the trends, outcomes, and their predictors in patients with cirrhosis undergoing BS. Materials and Methods A retrospective study was performed using the National Database from 2008 to 2013. Outcomes of BS in patients with cirrhosis were studied. In-hospital mortality, length of stay, and cost of care were compared between patients with no cirrhosis (NC), compensated cirrhosis (CC), and decompensated cirrhosis (DC). Multivariable logistic regression analysis was performed to study the predictors of mortality. Results Of the 558,017 admissions of patients who underwent BS during the study period, 3086 (0.55%) had CC and 103 (0.02%) had DC. An upward trend of vertical sleeve gastrectomy (VSG) utilization was seen during the study period. On multivariate analysis, mortality in CC was comparable with those in NC (aOR 1.88; CI 0.65-5.46); however, it was higher in DC (aOR 83.8; CI 19.3-363.8). Other predictors of mortality were older age (aOR 1.06; CI 1.04-1.08), male (aOR 2.59; CI 1.76-3.81), Medicare insurance (aOR 1.93; CI 1.24-3.01), lower income (aORs 0.44 to 0.55 for 2nd to 4th income quartile vs. 1st quartile), > 3 Elixhauser Comorbidity Index (aOR 5.30; CI 3.45-8.15), undergoing Roux-en-Y gastric bypass as opposed to VSG (aOR 3.90; CI 1.79-8.48), and centers performing < 50 BS per year (aOR 5.25; CI 3.38-8.15). Length of stay and hospital cost were also significantly higher in patients with cirrhosis as compared with those with NC. Conclusion Patients with compensated cirrhosis can be considered for bariatric surgery. However, careful selection of patients, procedure type, and volume of surgical center is integral in improving outcomes and healthcare utilization in patients with cirrhosis undergoing BS.This publication has 23 references indexed in Scilit:
- The impact of obesity on patient survival in liver transplant recipients: a meta‐analysisLiver International, 2014
- Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trialsBMJ, 2013
- Laparoscopic sleeve gastrectomy in patients with NASH-related cirrhosis: A case-matched studySurgery for Obesity and Related Diseases, 2013
- Comparable graft and patient survival in lean and obese liver transplant recipientsLiver Transplantation, 2013
- Bariatric surgery in patients with liver cirrhosisSurgery for Obesity and Related Diseases, 2013
- Increased Perioperative Mortality Following Bariatric Surgery Among Patients With CirrhosisClinical Gastroenterology and Hepatology, 2011
- Fewer Nutrient Deficiencies After Laparoscopic Sleeve Gastrectomy (LSG) than After Laparoscopic Roux-Y-Gastric Bypass (LRYGB)—a Prospective StudyObesity Surgery, 2010
- Evolving Consensus in Portal Hypertension Report of the Baveno IV Consensus Workshop on methodology of diagnosis and therapy in portal hypertensionJournal of Hepatology, 2005
- Cirrhosis is not a contraindication to laparoscopic surgerySurgical Endoscopy, 2004
- Endoscopic Management of Biliary Fistulas Complicating Liver Transplantation and Other Hepatobiliary OperationsAnnals of Surgery, 1993