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 Charlton

Research output: Contribution to journalArticle

23 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)310-315
Number of pages6
JournalObesity Surgery
Volume21
Issue number3
DOIs
StatePublished - Mar 2011

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Disease Resistance
Bariatric Surgery
Insulin Resistance
Body Mass Index
Serum Albumin
Liver
Obesity
Biliopancreatic Diversion
Gastric Bypass
Metabolome
Portal Hypertension
Obstructive Sleep Apnea
Infection
Non-alcoholic Fatty Liver Disease
Reoperation
Creatinine
Stomach
Histology
Fibrosis
Multivariate Analysis

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

NAFLD and insulin resistance do not increase the risk of postoperative complications among patients undergoing bariatric surgery-a prospective analysis. / Ribeireiro, Tarsila; Swain, James; Sarr, Michael; Kendrick, Michael; Que, Florencia; Sanderson, Schuyler; Krishnan, Anuradha; Viker, Kimberly; Watt, Kymberly; Charlton, Michael.

In: Obesity Surgery, Vol. 21, No. 3, 03.2011, p. 310-315.

Research output: Contribution to journalArticle

Ribeireiro, T, Swain, J, Sarr, M, Kendrick, M, Que, F, Sanderson, S, Krishnan, A, Viker, K, Watt, K & Charlton, M 2011, 'NAFLD and insulin resistance do not increase the risk of postoperative complications among patients undergoing bariatric surgery-a prospective analysis', Obesity Surgery, vol. 21, no. 3, pp. 310-315. https://doi.org/10.1007/s11695-010-0228-6
Ribeireiro, Tarsila ; Swain, James ; Sarr, Michael ; Kendrick, Michael ; Que, Florencia ; Sanderson, Schuyler ; Krishnan, Anuradha ; Viker, Kimberly ; Watt, Kymberly ; Charlton, Michael. / NAFLD and insulin resistance do not increase the risk of postoperative complications among patients undergoing bariatric surgery-a prospective analysis. In: Obesity Surgery. 2011 ; Vol. 21, No. 3. pp. 310-315.
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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.",
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T1 - NAFLD and insulin resistance do not increase the risk of postoperative complications among patients undergoing bariatric surgery-a prospective analysis

AU - Ribeireiro, Tarsila

AU - Swain, James

AU - Sarr, Michael

AU - Kendrick, Michael

AU - Que, Florencia

AU - Sanderson, Schuyler

AU - Krishnan, Anuradha

AU - Viker, Kimberly

AU - Watt, Kymberly

AU - Charlton, Michael

PY - 2011/3

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N2 - 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.

AB - 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.

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KW - Hepatic histopathology

KW - Morbid obesity

KW - NAFLD

KW - Nonalcoholic fatty liver disease

KW - Nonalcoholic steatohepatitis

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