TY - JOUR
T1 - NAFLD and insulin resistance do not increase the risk of postoperative complications among patients undergoing bariatric surgery-a prospective analysis
AU - Ribeireiro, Tarsila
AU - Swain, James
AU - Sarr, Michael
AU - Kendrick, Michael
AU - Que, Florencia
AU - Sanderson, Schuyler
AU - Krishnan, Anuradha
AU - Viker, Kimberly
AU - Watt, Kymberly
AU - Charlton, Michael
N1 - Funding Information:
Conflict of interest disclosure None of the authors have anything to disclose. This study was funded in its in entirety by the National Institutes of Health.
Funding Information:
This work has been supported by Public Health Service grant NIDDK RO1 DK069757-01 and GCRC RR00585. T.Ribeireiro.A.Krishnan.K.Viker.K.Watt.M.Charlton(*) Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA e-mail: [email protected]
PY - 2011/3
Y1 - 2011/3
N2 - Background Nonalcoholic fatty liver disease (NAFLD) and insulin resistance are common consequences of obesity and are highly prevalent among patients undergoing bariatric surgery. Insulin resistance and NAFLD have been reported to be associated with postoperative complications following major surgery. Methods We prospectively evaluated complications in a cohort of 437 consecutive patients undergoing bariatric surgery. Detailed metabolic profile was obtained prior to surgery, and liver biopsies were taken routinely during surgery. Results Mean age was 47.8 years (20-77), and mean body mass index (BMI) was 48.5 kg/m2 (32-94). Common co-morbid conditions were metabolic syndrome (79%), obstructive sleep apnea (73%), and hypertension (60%). Seventy-seven percent underwent Roux-en-Y gastric bypass, 15% biliopancreatic diversion with duodenal switch, and 8% adjustable gastric banding. The operative approach was laparoscopic in 81% of patients. Liver histology was normal in 22% of patients. Seventy-eight percent of patients had NAFLD. Nonalcoholic steatohepatitis (NASH) was present in 18%. Advanced fibrosis (stage 3-4) was present in 5%. Complications were observed in 25% of the cohort, the most frequent being infection, occurring in 14%. The wound was the most frequent site of infection (9%). There were no cases of postoperative hepatic decompensation. Reoperation was necessary in 7%. In univariate analysis, the factors associated with complications were male gender (p=0.009), type and approach of surgery (p=0.023 and p=0.0001, respectively), BMI (p=0.000), serum creatinine (p=0.023), and serum albumin (p=0.0001). In multivariate analysis, the independent factors associated with complications in bariatric surgery were BMI (OR 1.039, 95% CI 1.010-1.068; p= 0.008), surgical approach (OR 2.696, 95% CI 1.547-4.698; p=0.000), and serum albumin (OR 0.416, 95% CI 0.176-0.978; p=0.044). NASH was not predictive of complications. Conclusions Bariatric surgery is a safe and efficient treatment for obesity. The occurrence of NAFLD or NASH without portal hypertension should not preclude the procedure.
AB - Background Nonalcoholic fatty liver disease (NAFLD) and insulin resistance are common consequences of obesity and are highly prevalent among patients undergoing bariatric surgery. Insulin resistance and NAFLD have been reported to be associated with postoperative complications following major surgery. Methods We prospectively evaluated complications in a cohort of 437 consecutive patients undergoing bariatric surgery. Detailed metabolic profile was obtained prior to surgery, and liver biopsies were taken routinely during surgery. Results Mean age was 47.8 years (20-77), and mean body mass index (BMI) was 48.5 kg/m2 (32-94). Common co-morbid conditions were metabolic syndrome (79%), obstructive sleep apnea (73%), and hypertension (60%). Seventy-seven percent underwent Roux-en-Y gastric bypass, 15% biliopancreatic diversion with duodenal switch, and 8% adjustable gastric banding. The operative approach was laparoscopic in 81% of patients. Liver histology was normal in 22% of patients. Seventy-eight percent of patients had NAFLD. Nonalcoholic steatohepatitis (NASH) was present in 18%. Advanced fibrosis (stage 3-4) was present in 5%. Complications were observed in 25% of the cohort, the most frequent being infection, occurring in 14%. The wound was the most frequent site of infection (9%). There were no cases of postoperative hepatic decompensation. Reoperation was necessary in 7%. In univariate analysis, the factors associated with complications were male gender (p=0.009), type and approach of surgery (p=0.023 and p=0.0001, respectively), BMI (p=0.000), serum creatinine (p=0.023), and serum albumin (p=0.0001). In multivariate analysis, the independent factors associated with complications in bariatric surgery were BMI (OR 1.039, 95% CI 1.010-1.068; p= 0.008), surgical approach (OR 2.696, 95% CI 1.547-4.698; p=0.000), and serum albumin (OR 0.416, 95% CI 0.176-0.978; p=0.044). NASH was not predictive of complications. Conclusions Bariatric surgery is a safe and efficient treatment for obesity. The occurrence of NAFLD or NASH without portal hypertension should not preclude the procedure.
KW - Bariatric surgery
KW - Hepatic histopathology
KW - Morbid obesity
KW - NAFLD
KW - Nonalcoholic fatty liver disease
KW - Nonalcoholic steatohepatitis
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U2 - 10.1007/s11695-010-0228-6
DO - 10.1007/s11695-010-0228-6
M3 - Article
C2 - 20922498
AN - SCOPUS:79955767080
SN - 0960-8923
VL - 21
SP - 310
EP - 315
JO - Obesity Surgery
JF - Obesity Surgery
IS - 3
ER -