National trend and impact of compensated cirrhosis in patients who underwent metabolic and bariatric surgery: a Nationwide Readmissions Database study.

BACKGROUND

There is still a lack of sufficient data regarding the trend of cirrhosis and its impact on the perioperative and postoperative outcomes, and healthcare resource utilization in patients who underwent metabolic and bariatric surgery (MBS). Therefore, our study aimed to examine the impact of cirrhosis on MBS outcomes.

METHODS

The current study used the Nationwide Readmissions Database (NRD) 2016-2020. Patients who underwent MBS were divided into cirrhosis and non-cirrhosis groups. Patients younger than 18 years, those with a history of upper gastrointestinal malignancy, and patients with decompensated cirrhosis (portal hypertension, ascites, or varices) and individuals with a previous history of MBS were excluded.

RESULTS

The cirrhosis and non-cirrhosis groups consisted of 3064 and 538,329 patients, respectively. There was no significant change in the cirrhosis trend in patients who underwent MBS from 2016 to 2020. Cirrhosis was not associated with higher rates of in-hospital mortality (< 11 (< 0.36%) vs 99 (0.02%), p = 0.140), 90-day readmission (180 (6.57%) vs 24,204 (5.01%), p = 0.453), or most major complications. Although the overall incidence was low, cirrhosis was linked to higher rates of hepatic encephalopathy and acute heart failure. Patients with cirrhosis also had longer hospital stays, higher costs, and were more likely to have a non-home discharge. Among patients with cirrhosis, Roux-en-Y gastric bypass (OR 1.63, 95% CI 1.18-2.25, p = 0.003) and duodenal switch (OR 3.54, 95% CI 1.42-8.85, p = 0.007) were associated with a higher readmission rates compared to sleeve gastrectomy.

CONCLUSION

These results may indicate the safety of MBS in patients with compensated cirrhosis and obesity.