Characterizing liver disease in patients undergoing bariatric surgery: Prevalence and outcomes of 180,544 cases

Abstract

Background: The impact of liver disease on perioperative outcomes in bariatric surgery remains incompletely characterized. This study aims to determine the prevalence and outcomes of liver disease in patients who undergo bariatric surgery.

Methods: We conducted a retrospective analysis of 180,544 patients who underwent primary laparoscopic and robotic bariatric surgery in the 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Patients were stratified by presence of documented liver disease. Primary outcomes included 30-day complications and mortality. Multivariable logistic regression identified independent predictors of serious complications.

Results: Liver disease was present in 20,678 (11.5%) patients. Compared with patients without liver disease, those with liver disease were older (43.8 ±11.9 vs 42.9 ±11.9 years), less likely to be female (79.4% vs 82.5%), and had greater rates of diabetes (31.9% vs 22.5%), hypertension (48.1% vs 43.1%), and sleep apnea (47.9% vs 36.9%) (all P < .0001). Patients with liver disease experienced greater rates of anastomotic leak (0.3% vs 0.2%, P = .009), bleeding (1.2% vs 0.8%, P < .0001), reoperation (1.0% vs 0.8%, P = .001), and nonoperative reintervention (0.8% vs 0.6%, P < .0001). Overall serious complications were greater in the liver disease group (3.1% vs 2.4%, P < .0001), but mortality remained equivalent (0.07%, P = .855). On multivariable analysis, liver disease independently predicted serious complications (odds ratio, 1.18; 95% confidence interval, 1.09-1.29; P < .0001).

Conclusion: Liver disease is common among patients who undergo bariatric surgery and independently associated with increased perioperative complications but not mortality. Although the database lacks granular liver disease characterization preventing stratification by severity despite these short-term risks, bariatric surgery remains important for patients with liver disease, who-with specialized perioperative management-stand to gain significant long-term protection against disease progression.