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Bariatric Surgery and Hepatocellular Carcinoma: a Propensity Score-Matched Analysis

  • Basile Njei
  • Thomas R. McCarty
  • Prabin Sharma
  • Andrew Lange
  • Nilofar Najafian
  • Julius N. Ngu
  • Valmy E. Ngomba
  • Justin B. Echouffo-Tcheugui
Original Contributions

Abstract

Background

The association between obesity and rising incidence of hepatocellular carcinoma (HCC) in the USA has been documented; however, the role of bariatric surgery remains less clear.

Aim

To evaluate the cross-sectional association of prior-bariatric surgery and HCC.

Methods

The United States Nationwide Inpatient Sample (NIS) database was queried from 2004 to 2014 for discharges with a diagnosis of morbid obesity. Primary outcomes of interest were HCC and in-hospital mortality rate. Secondary outcomes were length of stay and cost. Baseline characteristics were balanced using propensity score matching (PSM). Using Poisson and logistic regressions, adjusted HCC prevalence ratio (PR) and mortality odds ratio (OR) were derived in patients with prior-bariatric surgery compared to those without bariatric surgery.

Results

Of the 2,881,414 patients included in our study, 267,082 (9.3%) underwent bariatric surgery. From 2004 to 2014, there was a threefold increase in age-adjusted prevalence of HCC from 27 per 100,000 to 72 per 100,000 (PTrend < 0.001). After PSM, 230,956 patients with prior-bariatric surgery were matched with 230,956 patients without bariatric surgery. Prior-bariatric surgery was associated with lower prevalence of HCC (PR 0.11; 95% CI, 0.03–0.48; P < 0.001). In-hospital mortality was also lower for patients with surgery (OR 0.22; 95% CI, 0.20–0.26; P < 0.001). The occurrence of HCC added $18,840 extra cost, increased mean length of stay by 2 (95% CI; 1–3) days, and increased risk of death by 65% (aOR 1.65; 95% CI 1.18–2.29).

Conclusion

In this nationwide study of morbidly obese patients, prior-bariatric surgery was associated with a lower prevalence of HCC and lower in-patient mortality.

Keywords

Obesity Bariatric surgery Weight loss Hepatocellular carcinoma (HCC) 

Notes

Financial Support

This study is financially supported by NIH 5 T32 DK 7356-37 (BN).

Author Contributions

Study concept and design—Njei B, McCarty TR, and Sharma P

Paper preparation—Njei B, McCarty TR, and Sharma P

Statistical analysis—Njei B

Critical revisions—McCarty TR, Sharma P, Lange A, Najafian N, Ngu JN, VE Ngomba, Echouffo-Tcheugui JB

Compliance with Ethical Standards

All authors approved of the final version of the manuscript.

This article has not been published and is not under consideration elsewhere.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval Statement

For this type of study formal consent is not required.

Informed Consent Statement

Does not apply.

STROBE Statement

All checklist items for cross-sectional studies have been completed.

Supplementary material

11695_2018_3431_Fig5_ESM.png (1.1 mb)
Supplemental Figure 1

Graph of Propensity Score Densities before and after 1:1 Fixed Ratio nearest Neighbor Matching (PNG 1113 kb)

11695_2018_3431_MOESM1_ESM.tiff (28 kb)
High resolution image (TIFF 28 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Basile Njei
    • 1
  • Thomas R. McCarty
    • 2
  • Prabin Sharma
    • 2
    • 3
  • Andrew Lange
    • 2
  • Nilofar Najafian
    • 2
  • Julius N. Ngu
    • 4
  • Valmy E. Ngomba
    • 5
  • Justin B. Echouffo-Tcheugui
    • 6
    • 7
  1. 1.Section of Digestive DiseasesYale University School of MedicineNew HavenUSA
  2. 2.Department of Internal MedicineYale University School of MedicineNew HavenUSA
  3. 3.Department of Internal MedicineYale New Haven Health-Bridgeport HospitalBridgeportUSA
  4. 4.Department of SurgeryUniversity of Texas Medical BranchGalvestonUSA
  5. 5.Department of Internal MedicineRichmond University Medical CenterStaten IslandUSA
  6. 6.Division of Endocrinology, Diabetes and HypertensionBrigham and Women’s HospitalBostonUSA
  7. 7.Harvard Medical SchoolBostonUSA

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