BACKGROUND: Chronic liver disease (CLD) is a risk factor for surgical complications and a relative contraindication to bariatric surgery. This study evaluates early outcomes after bariatric surgery in patients with CLD with and without liver cirrhosis (LC).

METHODS: In a retrospective analysis of 2012–2016 Healthcare Cost and Utilization Project-National Inpatient Sample, adult patients with obesity undergoing laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were studied. CLD and LC were identified along with patient comorbidities. Outcomes were Long Hospital Stay (LHS) defined as ≥5 days (as a proxy of complicated course), blood product transfusion, total hospital charges, and in-hospital mortality. Binary logistic regression was used for multivariate analysis (MVA).

RESULTS: 139,952 patients were analyzed (RYGB 36.6%, female 78.6%, age 44.7±12 years). CLD was listed in 17,423 (12.4%) patients, including 818 (0.6%) with LC. Non-alcoholic fatty liver disease was the most common cause of CLD. Patients with LC were more likely to be older, male, and have diabetes mellitus and hyperlipidemia. 37.7% of LC and 42.1% of non-cirrhotic CLD patients underwent RYGB. Transfusion, LHS, and total charges were higher in the LC group (Table). In-hospital mortality was higher in CLD (0.1%) and LC (<0.3%). In MVA, LC was an independent predictor of LHS (Odds Ratio (OR): 1.82, 95% CI: 1.25-2.67) but non-cirrhotic CLD was not a predictor of LHS. Subgroup MVA in CLD showed RYGB was independently associated with LHS (OR: 1.85, 95% CI: 1.53-2.25).

CONCLUSION: Bariatric surgery can be performed safely in appropriately selected patients with non-cirrhotic CLD and LC. Further studies are needed to assess long-term outcomes of bariatric surgery in CLD.