Increased perioperative mortality following bariatric surgery among patients with cirrhosis

Mosko, Jeffrey D.; Nguyen, Geoffrey C.

doi:10.1016/j.cgh.2011.07.007

Cited by 266Bariatric Surgery and OutcomesLiver Disease and TransplantationCardiac, Anesthesia and Surgical Outcomes

Increased perioperative mortality following bariatric surgery among patients with cirrhosis

Mosko, Jeffrey D., Nguyen, Geoffrey C.·2011·Clinical Gastroenterology and Hepatology

DOI 10.1016/j.cgh.2011.07.007

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Abstract

Background & aims The prevalence of nonalcoholic fatty liver disease and ensuing cirrhosis is expected to increase as a result of the obesity epidemic. These trends might increase the number of bariatric surgeries among patients with cirrhosis. We sought to assess the impact of cirrhosis on perioperative mortality after bariatric procedures.Methods Data on patients who underwent bariatric surgery in the United States between 1998 and 2007 were extracted from the Nationwide Inpatient Sample. In-hospital mortality and length of stay were compared for patients with no cirrhosis, compensated cirrhosis, and decompensated cirrhosis.Results Patients without cirrhosis had lower mortality rates than those with compensated and decompensated cirrhosis (0.3% vs 0.9% and 16.3%, respectively, P = .0002). After adjusting for covariates, the adjusted odds ratio of mortality among compensated and decompensated cirrhotic patients compared with noncirrhotic patients was 2.17 (95% confidence interval, 1.03-4.55) and 21.2 (95% confidence interval, 5.39-82.9), respectively. Mortality increased with volume of surgery among centers; those with more than 100 surgeries per year had the lowest mortality rates, compared with those with 50 to 100 surgeries per year and fewer than 50 surgeries per year (0.2% vs 0.4% and 0.7%, respectively; P < .0001). The average length of stay was longer for patients with decompensated and compensated cirrhosis, compared with patients without liver disease (6.7 and 4.4 d vs 3.2 d, respectively; P = .0001 and P = .03).Conclusions Bariatric surgery in patients with cirrhosis should be performed while liver disease is well compensated. Patients with cirrhosis should undergo surgery at centers that perform large numbers of these procedures.

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Individuals with decompensated cirrhosis have a 10-fold higher risk of death after bariatric surgery than those with compensated cirrhosis.
“Individuals with decompensated cirrhosis have a 10-fold higher risk of death after bariatric surgery than those with compensated cirrhosis 503 and are thus not good candidates for this procedure.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [503]

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Authors: Mosko, J. D., & Nguyen, G. C.
Affiliations: Mount Sinai Hospital (CA)
Corresponding author: Nguyen, Geoffrey C.
ORCID: Mosko, Jeffrey D.
Nguyen, Geoffrey C.
Venue: Clinical Gastroenterology and Hepatology
Publisher: Elsevier BV
Published: 2011-10
Volume: 9
Issue: 10
Pages: 897-901
ISSN: 1542-3565 (ISSN-L)
DOI: 10.1016/j.cgh.2011.07.007
OpenAlex: W2136166567
Cited by: 266
References: 17
Citations by year: 2026: 10 · 2025: 15 · 2024: 20 · 2023: 18 · 2022: 22 · 2021: 27 · 2020: 32 · 2019: 19 · 2018: 19 · 2017: 14 · 2016: 13 · 2015: 21 · 2014: 13 · 2013: 13 · 2012: 9
FWCI: 11.80
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Gastroenterology and Hepatology (publishedVersion)
PubMed (publishedVersion)
Funders: Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords: bariatric surgery, liver cirrhosis, perioperative mortality, decompensated cirrhosis, compensated cirrhosis, non-alcoholic fatty liver disease, obesity, length of hospital stay, in-hospital mortality
MeSH terms: Adult, Female, Fibrosis, Humans, Length of Stay, Male, Middle Aged, Obesity, Morbid, United States, Survival Analysis, Bariatric Surgery

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Increased perioperative mortality following bariatric surgery among patients with cirrhosis

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