Outcomes of Bariatric Surgery in Chronic Liver Disease: a National Inpatient Sample Analysis

Abstract

Obesity is a challenging condition to treat in patients with chronic liver disease (CLD). The safety and efficacy of bariatric surgery (BS) in patients with CLD is not well established. The aim of this study is to evaluate outcomes of BS in patients with CLD. Data from the National Inpatient Sample for 2012-2015, accounting for over 7 million discharges, were analyzed. All patients undergoing BS were identified using ICD-9/CPT codes. Patients were then stratified based on the presence of CLD using ICD-9 codes. Primary outcomes included inpatient mortality, length of stay (LOS), and total hospital charges (THC). Secondary outcomes, including infection, bleeding, improper wound healing, and surgical revision, were identified using ICD-9 codes. A total of 302,306 patients underwent BS, of which 20,095 (6.6%) were diagnosed with CLD. CLD patients had greater inpatient mortality, with adjusted odds ratio of 1.47 (95% CI 1.24-1.73). CLD patients also had greater THC but shorter LOS. CLD patients had significantly less surgical revision, improper wound healing, and postoperative infection. There was no difference in bleeding complications between groups. Inpatient mortality following BS in CLD patients is low; however, there was an increased risk compared with the non-CLD population. Postoperative complications were no different or even less frequent in CLD patients compared with the general population. BS should not be discounted as a treatment option for obesity in patients with CLD.