ABSTRACT

Objectives: Since there is increasing number of patients with cirrhosis who require the bariatric procedure due to obesity and obesity-related nonalcoholic steatohepatitis fibrosis, we evaluate the effect of cirrhosis on post-bariatric surgery outcomes.

Methods: 2011–2017 National Inpatient Sample was used to isolate bariatric cases, which were stratified by cirrhosis; controls were propensity-score matched to cases and compared to endpoints: mortality, length of stay (LOS), costs, and postoperative complications.

Results: From 190,753 patients undergoing bariatric surgery, there were 957 with cirrhosis and 957 matched controls. There was no difference in mortality (0.94 vs 0.52% p = 0.42, OR 1.81 95%CI 0.60–5.41); however, cirrhosis patients had higher LOS (3.36 vs 2.89d p = 0.002), costs ($68,671 vs $61,301 p < 0.001), and bleeding (2.09 vs 0.72% p < 0.001, OR 2.95 95%CI 1.89–4.61). In multivariate, there was no difference in mortality (p = 0.330, aOR 1.73 95%CI 0.58–5.19). In subgroup comparison of cirrhosis patients, those with decompensated cirrhosis had higher mortality (7.69 vs 0.94% p < 0.001, OR 8.78 95%CI 3.41–22.59).

Conclusion: The results of this study show compensated cirrhosis does not pose an increased risk toward post-bariatric surgery mortality; however, hepatic decompensation increases the postsurgical risks.

摘要

目的：由于越来越多的肝硬化患者因肥胖和肥胖相关的非酒精性脂肪性肝炎纤维化而需要进行减肥手术，我们评估了肝硬化对减肥手术后结果的影响。

方法：采用2011-2017年全国住院样本分离减肥病例，按肝硬化分层；对照是与病例匹配的倾向评分，并与终点进行比较：死亡率、住院时间 (LOS)、成本和术后并发症。

结果：在接受减肥手术的 190,753 名患者中，有 957 名肝硬化患者和 957 名匹配对照。死亡率没有差异（0.94 vs 0.52% p = 0.42，OR 1.81 95%CI 0.60–5.41）；然而，肝硬化患者的 LOS（3.36 对 2.89dp = 0.002）、成本（68,671 美元对 61,301 美元 p < 0.001）和出血（2.09 对 0.72% p < 0.001，OR 2.95 95%CI 1.89–4.61）更高。在多变量中，死亡率没有差异（p = 0.330，aOR 1.73 95%CI 0.58–5.19）。在肝硬化患者的亚组比较中，失代偿期肝硬化患者的死亡率更高（7.69 vs 0.94% p < 0.001，OR 8.78 95%CI 3.41–22.59）。

结论：这项研究的结果表明，代偿期肝硬化不会增加减肥手术后死亡率的风险；然而，肝功能失代偿会增加术后风险。