Nonalcoholic fatty liver disease does not predict worse perioperative outcomes in bariatric surgery

Abstract

Nonalcoholic fatty liver disease (NAFLD) occurs in 84–95% of obese individuals. Bariatric surgery (BS) is an effective treatment of obesity, with a potential sustained weight loss of 21–45%. The safety and efficacy of BS among NAFLD patients is not well established. The aim of this study was to determine outcomes for patients with NAFLD undergoing BS compared to patients without. MethodsAll adults undergoing BS were identified from the National Inpatient Sample 2012–2015 and stratified based on the presence of NAFLD using ICD-9/CPT codes. Primary outcomes included inpatient mortality, length of stay (LOS), and total hospital charges (THC). Secondary outcomes included infection, bleeding, improper wound healing and surgical revision. Results302,306 patients underwent BS, of which 15,607 had NAFLD and 286,699 did not (non-NAFLD). NAFLD patients had 35% lower inpatient mortality and shorter LOS, but slightly greater THC. NAFLD patients had smaller risk of improper wound healing and post-operative infection. There was no difference in bleeding, or incidence of surgical revision between groups. ConclusionNAFLD patients had lower mortality and complication rates following BS. A significant postsurgical weight loss should attenuate liver inflammation and fibrosis, and therefore has the potential to stop or even reverse progression of liver disease.