Bariatric Surgery Improves Clinical Outcomes in Hospitalizations for NAFLD

Rayna Patel, MD

Credit: The University of Toledo

A new retrospective analysis, presented at Digestive Disease Week (DDW) 2024, evaluated the impact of bariatric surgery on hospital outcomes in patients admitted with non-alcoholic fatty liver disease (NAFLD) in the United States in 2020.¹

Among more than 82,000 patients identified in the analysis, patients with NAFLD who underwent bariatric surgery exhibited lower inpatient mortality, a shorter length of stay, and lower hospitalization costs.

“Our study comparing bariatric surgery as an intervention for patients with NAFLD suggests that bariatric surgery is associated with improved clinical outcomes, including lower mortality rates, shorter hospital stays, and potentially more cost-effective healthcare resource utilization in patients admitted with NAFLD,” wrote the investigative team, led by Rayna Patel, MD, The University of Toledo - Health Science Campus.

Owing to the rising global prevalence of diabetes and obesity, the harmful impact of NAFLD has posed a significant challenge to public health.² In recent years, NAFLD has become the most common chronic liver disease in the Western world and is closely linked to metabolic disorders, including obesity and hypertension.

Lifestyle modifications, including weight loss and diet, as well as the treatment of underlying metabolic syndrome, are the standard of care once a diagnosis is made, with promising results.² However, as these modifications are difficult to maintain, further effort can be required to achieve the necessary outcomes.

Bariatric surgery has proven an effective intervention that leads to significant, long-term weight, suggesting its potential as a treatment option for those with NAFLD.³ In this study, Patel and colleagues sought to evaluate the association of patients who had undergone bariatric surgery with the outcomes of those hospitalized with NAFLD.¹

To assess this association, the retrospective analysis involved adults hospitalized with NAFLD who underwent bariatric surgery in the US in 2020. These patients were identified using the National Inpatient Sample (NIS) database of the Healthcare Utilization Project (HCUP).

Baseline characteristics were collected for individuals who had NAFLD and Patel and colleagues separated the population into two groups, based on undergoing bariatric surgery or not undergoing the surgery. A comparison was performed between the two groups for clinical outcomes, including in-hospital mortality, length of stay, and total hospital charges.

Encompassing 82,414 admitted patients who previously underwent bariatric surgery, the study identified 1,295 individuals as having NAFLD. Patient characteristics showed a predominance of female (61%) patients and most were White (75%), followed by Hispanic (14%) and Black (4.8%). In addition, most patients demonstrated comorbidities, including obesity (41%), complicated hypertension (34%), and chronic pulmonary disease (23%).

Patel and colleagues indicated comparing the outcomes between NAFLD patients with and without bariatric surgery led to significant between-group differences.

Upon analysis, those in the bariatric surgery cohort exhibited lower inpatient mortality (<1% vs. 4.2%, P = .007) compared with the non-bariatric surgery group. Individuals in the bariatric surgery group also exhibited a shorter length of stay (2.7 ± 0.5 days vs. 6.0 ± 0.1 days) versus the non-surgery group, as well as slightly lower hospitalization costs ($ 74,516 ± $9,308 vs. $77, 430 ± $3,900).

References

1. _{Patel R, Alharbi A, Chinnam S, Dhoop SM, Iqbal A, et al. IMPACT OF BARIATRIC SURGERY ON HOSPITAL OUTCOMES IN PATIENTS ADMITTED WITH NON-ALCOHOLIC FATTY LIVER DISEASE: A 2020 RETROSPECTIVE ANALYSIS IN THE UNITED STATES. Lecture presented at Digestive Disease Week 2024, May 18 - 21, 2024.}
2. _{Pouwels S, Sakran N, Graham Y, et al. Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss. BMC Endocr Disord. 2022;22(1):63. Published 2022 Mar 14. doi:10.1186/s12902-022-00980-1}
3. _{Geerts A, Lefere S. Bariatric surgery for non-alcoholic fatty liver disease: Indications and post-operative management. Clin Mol Hepatol. 2023;29(Suppl):S276-S285. doi:10.3350/cmh.2022.0373}