S0985 The Clinical Impact of Cirrhosis on the Postprocedural Outcomes of Patients Undergoing Bariatric Procedures: 2011-2017 Analysis of U.S. Hospitals

Abstract

INTRODUCTION: Bariatric surgery is offered to patients with morbid obesity and nonalcoholic steatohepatitis (NASH) as a standard of care procedure. However, a proportion of these patients have underlying cirrhosis and are therefore at an increased risk of postoperative complications following bariatric surgery due to cirrhosis-related comorbidities. METHODS: Patients who underwent bariatric procedures (gastric sleeve, open and laparoscopic gastric bypass, and other restrictive gastric procedures) were selected from the 2011 to 2017 National Inpatient Sample and were stratified by the presence of cirrhosis. The study endpoints included mortality, length of stay (LOS), hospitalization costs, and postprocedural complications. RESULTS: Of the 191749 bariatric surgery patients identified from the database, 1109 of these patients also had cirrhosis. The cirrhosis patients were older (55 vs 45.4y P < 0.01) and were more likely to be male (33.1 vs 22.0% P < 0.01). Mortality was higher among the cirrhosis patients (1.62 vs 0.23% P < 0.01, OR 7.21 95% CI 4.49–11.6), as were LOS (4.02 vs 2.47d P < 0.01) and total hospitalization costs ($81,301 vs $56,015 P < 0.01). The cirrhosis patients had lower incidences of obesity (87.4 vs 95.8% P < 0.01, OR 0.30 95% CI 0.25–0.36) and morbid obesity (84.9 vs 94.6% P < 0.01, OR 0.32 95% CI 0.27–0.38). However, the cirrhosis patients had higher incidences of postoperative bleeding (2.52 vs 0.70% P < 0.01, OR 3.65 95% CI 2.50–5.33) and wound complications (0.63 vs 0.14% P < 0.01, OR 4.51 95% CI 2.13–9.58). No differences between cohorts were found in the incidences of bowel perforation (0.36 vs 0.14% P = 0.07, OR 2.62 95% CI 0.71–6.81), bowel obstruction (0.81 vs 0.61% P = 0.5, OR 1.34 95% CI 0.69–2.59), and postoperative infection (0.18 vs 0.11% P = 0.33 OR 1.69 95% CI 0.20–6.22). In a multivariate model that included cirrhosis and hepatic events, hepatic encephalopathy (P < 0.01, aOR 7.76 95% CI 1.97–25.9), ascites (P = 0.01, aOR 1.60 95% CI 1.09–2.32), and hepatorenal syndrome (P = 0.02, aOR 8.68 95% CI 1.44–55.6) were associated with postprocedural mortality. CONCLUSION: Cirrhosis-related complications, including hepatic encephalopathy, ascites, and hepatorenal syndrome, are associated with increased postoperative mortality in bariatric surgery patients. These patients therefore require early risk-assessment and multidisciplinary management of cirrhosis-related complications in order to optimize postoperative outcomes.Figure 1.: Multivariate model: hepatic encephalopathy, ascites, and hepatorenal syndrome are associated with postprocedural mortality in patients undergoing bariatric procedures.