Hepatobiliary surgery and nutrition · 2025
Enhanced long-term outcomes with laparoscopic bariatric surgery in patients with severe obesity and metabolic dysfunction-associated steatotic liver disease: a retrospective cohort study.
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Zhang Xinrong, Rouillard Nicholas, Mao Xianhua, Lai Rongtao, Cheung Ramsey, Sasaki Kazunari, Nguyen Mindie H
Аннотация
BACKGROUND: Bariatric surgery is a potential treatment for weight loss in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and severe obesity. However, the impact of bariatric surgery types on long-term outcomes and healthcare utilization in this population has not been well characterized. We aimed to compare long-term outcomes and healthcare utilization between laparoscopic and open bariatric surgery in patients with MASLD and severe obesity.
METHODS: We conducted a retrospective cohort of adult patients with MASLD and severe obesity [body mass index (BMI) ≥35 kg/m2] who underwent laparoscopic or open bariatric surgery between 2007 and 2022 using Marketscan® Research Databases, with patient baseline characteristics in the two study arms balanced via propensity score matching (PSM). The primary outcomes were liver and non-liver outcomes including cardiovascular disease (CVD), chronic kidney disease (CKD), and obesity-related cancers.
RESULTS: The study included 46,476 patients with MASLD and severe obesity. A 1:1 PSM yielded 5,629 matched pairs of patients with laparoscopic or open bariatric surgery for analysis. Among different bariatric surgery types, Roux-en-Y gastric bypass (RYGB) was the dominant procedure up to 2012, whereas over 50% of bariatric procedures were sleeve gastrectomy (SG) after 2015. In multivariable analysis, laparoscopic surgery was associated with a 47% reduced risk of any liver-related outcomes [adjusted hazard ratio (aHR) =0.53; 95% confidence interval (CI): 0.42-0.67; P<0.001], 67% reduced risk of CVD (aHR =0.33; 95% CI: 0.28-0.40; P<0.001), 56% reduced risk of CKD (aHR =0.44; 95% CI: 0.36-0.54; P<0.001), and 42% reduced risk of obesity-related cancers (aHR =0.58; 95% CI: 0.42-0.80; P<0.001), compared to those with open surgery. Patients with laparoscopic surgery had fewer hospitalization (0.04 vs. 0.06, P=0.04), emergency department (ED) (0.03 vs. 0.08, P=0.01), and outpatient visits (2.09 vs. 2.63, P=0.01), and lower pharmacy costs ($21,766 vs. $24,353, P<0.001) annually than those with open surgery.
CONCLUSIONS: Laparoscopic surgery is a promising potential treatment for patients with MASLD and severe obesity with more favorable long-term outcomes and healthcare utilization and costs than open surgery. Randomized clinical trials and additional cost-effectiveness analysis are needed to corroborate the findings.
METHODS: We conducted a retrospective cohort of adult patients with MASLD and severe obesity [body mass index (BMI) ≥35 kg/m2] who underwent laparoscopic or open bariatric surgery between 2007 and 2022 using Marketscan® Research Databases, with patient baseline characteristics in the two study arms balanced via propensity score matching (PSM). The primary outcomes were liver and non-liver outcomes including cardiovascular disease (CVD), chronic kidney disease (CKD), and obesity-related cancers.
RESULTS: The study included 46,476 patients with MASLD and severe obesity. A 1:1 PSM yielded 5,629 matched pairs of patients with laparoscopic or open bariatric surgery for analysis. Among different bariatric surgery types, Roux-en-Y gastric bypass (RYGB) was the dominant procedure up to 2012, whereas over 50% of bariatric procedures were sleeve gastrectomy (SG) after 2015. In multivariable analysis, laparoscopic surgery was associated with a 47% reduced risk of any liver-related outcomes [adjusted hazard ratio (aHR) =0.53; 95% confidence interval (CI): 0.42-0.67; P<0.001], 67% reduced risk of CVD (aHR =0.33; 95% CI: 0.28-0.40; P<0.001), 56% reduced risk of CKD (aHR =0.44; 95% CI: 0.36-0.54; P<0.001), and 42% reduced risk of obesity-related cancers (aHR =0.58; 95% CI: 0.42-0.80; P<0.001), compared to those with open surgery. Patients with laparoscopic surgery had fewer hospitalization (0.04 vs. 0.06, P=0.04), emergency department (ED) (0.03 vs. 0.08, P=0.01), and outpatient visits (2.09 vs. 2.63, P=0.01), and lower pharmacy costs ($21,766 vs. $24,353, P<0.001) annually than those with open surgery.
CONCLUSIONS: Laparoscopic surgery is a promising potential treatment for patients with MASLD and severe obesity with more favorable long-term outcomes and healthcare utilization and costs than open surgery. Randomized clinical trials and additional cost-effectiveness analysis are needed to corroborate the findings.