Taha Qazi, MD: Impact of Bariatric Surgery on Cirrhosis, Liver Disease Outcomes

Given recent increases in the prevalence of obesity, both metabolic dysfunction-associated steatotic liver disease (MASLD) and bariatric surgery are becoming increasingly common, with bariatric surgery offering numerous benefits for MASLD outcomes. However, even after bariatric surgery, fibrosis may still progress and patients remain susceptible to other causes of cirrhosis, either through progressive steatosis or other mechanisms.

The sixth issue of Qazi Corner, a collaborative quarterly newsletter on gastroenterology research, news, and trends between HCPLive and editor-in-chief Taha Qazi, MD, highlights the effect of bariatric surgery on outcomes of cirrhosis decompensation events with a retrospective, population-based analysis using the National Inpatient Sample database from October 2015 – December 2020.

Investigators identified adult patients with obesity hospitalized with decompensated cirrhosis, including ascites, variceal hemorrhage, hepatic encephalopathy, or portal hypertension, stratified based on whether or not they had a history of bariatric surgery. Study results showed the bariatric surgery cohort had better outcomes for rates of inpatient mortality; acute kidney injury; respiratory failure requiring mechanical ventilation; and upper GI bleed. Although bariatric surgery was protective against inpatient mortality in univariate analysis, significance was lost in multivariate analysis.

“In these patients who received a bariatric procedure of some sort to alleviate their metabolic associated liver disease, they actually did very well, and I think that’s a good thing to consider as our armamentarium of bariatric procedures improves,” Qazi, a gastroenterologist with the Cleveland Clinic, said to HCPLive.

Investigators pointed to improved outcomes among patients with obesity and a history of bariatric surgery hospitalized with decompensated cirrhosis compared to nonsurgical patients, something they said likely relates to overall improved metabolic and comorbid health conferred by bariatric surgery. However, they also called attention to the need for future analyses to better understand this relationship.