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Obesity Surgery

, Volume 21, Issue 3, pp 310–315 | Cite as

NAFLD and Insulin Resistance Do Not Increase the Risk of Postoperative Complications Among Patients Undergoing Bariatric Surgery—A Prospective Analysis

  • Tarsila Ribeireiro
  • James Swain
  • Michael Sarr
  • Michael Kendrick
  • Florencia Que
  • Schuyler Sanderson
  • Anuradha Krishnan
  • Kimberly Viker
  • Kymberly Watt
  • Michael CharltonEmail author
Clinical Research

Abstract

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.

Keywords

Nonalcoholic fatty liver disease NAFLD Nonalcoholic steatohepatitis Morbid obesity Bariatric surgery Hepatic histopathology 

Notes

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.

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Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Tarsila Ribeireiro
    • 1
  • James Swain
    • 2
  • Michael Sarr
    • 2
  • Michael Kendrick
    • 2
  • Florencia Que
    • 2
  • Schuyler Sanderson
    • 3
  • Anuradha Krishnan
    • 1
  • Kimberly Viker
    • 1
  • Kymberly Watt
    • 1
  • Michael Charlton
    • 1
    Email author
  1. 1.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA
  2. 2.Department of SurgeryMayo ClinicRochesterUSA
  3. 3.Division of Anatomic PathologyMayo ClinicRochesterUSA

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