Nonalcoholic Steatohepatitis (NASH) Does Not Increase Complications After Laparoscopic Bariatric Surgery
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Advanced liver disease is associated with increased risk for postoperative complications. It is not well known whether the presence of nonalcoholic steatohepatitis (NASH) in morbidly obese patients contributes to the rate of postoperative complications. The main objective was to study the association between NASH and postoperative complications in bariatric patients.
A total of 340 contemporary sequential patients who underwent laparoscopic bariatric operations and who had intraoperative liver biopsies were studied. The rates of severe postoperative complications were compared across three patient groups—those with (1) no liver disease or with simple steatosis, (2) mild nonalcoholic NASH [steatosis with necroinflammation and mild fibrosis (stage 0–1)], and (3) advanced NASH [steatosis, necroinflammation, and more advanced fibrosis (stage ≥ 2)].
Of 340 patients, 141 (42%) had no NASH, and 151 (44%) and 48 (14%) had mild and advanced NASH, respectively. Superobesity (P = 0.037), diabetes (P < 0.001), and cerebrovascular disease (P = 0.013) had highest frequencies in patients with advanced NASH. Hypertension was highly prevalent in cohort (57%) but similarly distributed across three groups. Forty-five patients experienced at least one complication (pulmonary 4, cardiovascular 8, surgical 16, and acute kidney injury 21). The complications rate did not differ significantly across NASH categories. Median hospital stay was 3 days (IQR 2, 3), and it was not associated with NASH severity. There were no 30-day postoperative deaths.
Despite the high prevalence of NASH among morbidly obese surgical patients, this condition was not associated with increased risk for postoperative complications. Postoperative acute kidney injury was the most frequent single complications.
KeywordsAnesthesia: general Surgery bariatric Complications: perioperative Nonalcoholic fatty liver disease Steatohepatitis Acute kidney injury
We are thankful to Dr. Thomas Smyrk, associate professor of Pathology, for sharing histopathology slides and advice, Miss Ashley Nadeau (statistical programmer/analyst) for data management and statistical assistance. This work was supported by the Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Conflicts of interest
The authors declare that they have no conflicts of interest.
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