Mo2044 Sleeve Gastrectomy in Obese Mice Improves NAFLD Independent of Hepatic Small Heterodimer Partner (SHP, Nrob2) Activation

Abstract

BACKGROUND: Bariatric surgery is an effective method for achieving sustainable weight loss and health benefit in the morbidly obese population. Although inflammatory bowel disease (IBD) is often associated with malnutrition and weight loss, there has been a temporal increase in the prevalence of obesity among IBD patients. We evaluate the effect of IBD on post-surgical complications and health care utilization among inpatient gastric bypass procedures for obesity. METHODS: The Nationwide Inpatient Sample (NIS) was analyzed for all hospitalizations between 1998 through 2011 with accompanying Roux-en-Y gastric bypass surgery (ICD-9-CM 44.31, 44.38, 44.39) for obesity (ICD-9-CM 278, V778, V853V854, V855.4). IBD hospitalizations were identified using ICD-9-CM 555 and 556 in any diagnosis position. Logistic and linear regression analyses were used to assess the effect of IBD on post-operative complications, inpatient mortality, post-operative length of stay, and total charges. Multivariable models were adjusted for age, sex, payer source, medical comorbidities, and hospital size. RESULTS: Of 933,930 inpatient gastric bypasses for obesity, 967 were performed on IBD patients. Most gastric bypass patients were female (81.5%) with a mean age of 43.0 years. Compared with non-IBD patients, IBD patients were more likely to require conversion from laparoscopic to open surgery (odds ratio [OR] 3.30; 95% confidence interval [CI] 1.55 7.04). IBD patients were also significantly more likely to experience post-surgical complications, including seromas (OR 12.46; 95% CI 1.72 90.39), infections (OR 2.80; 95% CI 1.15 6.83), and gastrointestinal issues (e.g., vomiting, ileus, obstruction) (OR 2.77; 95% CI 1.55 4.98). There were no differences in perforation risk (OR 0.88; 95% CI 0.22 3.54), pulmonary (OR 0.73; 95% CI 0.30 1.77) or cardiovascular complications (OR 1.22; 95% CI 0.39 3.83), or death (0.52% vs. 0.22%; OR 2.04; 95% CI 0.28 14.67). Length of stay, post-operative length of stay, and total charges were similar between non-IBD and IBD hospitalizations. CONCLUSION: IBD is associated with seromas, infections, and gastrointestinal complications after bariatric surgery. Risk of other major complications, death, and hospitalization costs were otherwise similar between IBD and non-IBD patients. The rate of conversion from laparoscopic to open surgery was significantly higher in patients with IBD. Bariatric surgery remains a viable option for treatment of obesity in this special population.