Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery

Toby N. Weingarten, James M. Swain, Michael L. Kendrick, Michael R. Charlton, Brent J. Schroeder, Robert E Citrowske Lee, Bradly J. Narr, Tarsila C R Ribeiro, Darrell R. Schroeder, Juraj Sprung

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: 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. Methods: 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)]. Results 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1714-1720
Number of pages7
JournalObesity Surgery
Volume21
Issue number11
DOIs
StatePublished - Nov 2011

Fingerprint

Bariatric Surgery
Laparoscopy
Bariatrics
Acute Kidney Injury
Liver Diseases
Fibrosis
Non-alcoholic Fatty Liver Disease
Cerebrovascular Disorders
Length of Stay
Hypertension
Biopsy
Lung

Keywords

  • Acute kidney injury
  • Anesthesia: general
  • Complications: perioperative
  • Nonalcoholic fatty liver disease
  • Steatohepatitis
  • Surgery bariatric

ASJC Scopus subject areas

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

Cite this

Weingarten, T. N., Swain, J. M., Kendrick, M. L., Charlton, M. R., Schroeder, B. J., Lee, R. E. C., ... Sprung, J. (2011). Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery. Obesity Surgery, 21(11), 1714-1720. https://doi.org/10.1007/s11695-011-0521-z

Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery. / Weingarten, Toby N.; Swain, James M.; Kendrick, Michael L.; Charlton, Michael R.; Schroeder, Brent J.; Lee, Robert E Citrowske; Narr, Bradly J.; Ribeiro, Tarsila C R; Schroeder, Darrell R.; Sprung, Juraj.

In: Obesity Surgery, Vol. 21, No. 11, 11.2011, p. 1714-1720.

Research output: Contribution to journalArticle

Weingarten, TN, Swain, JM, Kendrick, ML, Charlton, MR, Schroeder, BJ, Lee, REC, Narr, BJ, Ribeiro, TCR, Schroeder, DR & Sprung, J 2011, 'Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery', Obesity Surgery, vol. 21, no. 11, pp. 1714-1720. https://doi.org/10.1007/s11695-011-0521-z
Weingarten TN, Swain JM, Kendrick ML, Charlton MR, Schroeder BJ, Lee REC et al. Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery. Obesity Surgery. 2011 Nov;21(11):1714-1720. https://doi.org/10.1007/s11695-011-0521-z
Weingarten, Toby N. ; Swain, James M. ; Kendrick, Michael L. ; Charlton, Michael R. ; Schroeder, Brent J. ; Lee, Robert E Citrowske ; Narr, Bradly J. ; Ribeiro, Tarsila C R ; Schroeder, Darrell R. ; Sprung, Juraj. / Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery. In: Obesity Surgery. 2011 ; Vol. 21, No. 11. pp. 1714-1720.
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abstract = "Background: 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. Methods: 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)]. Results 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. Conclusions: 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.",
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AU - Weingarten, Toby N.

AU - Swain, James M.

AU - Kendrick, Michael L.

AU - Charlton, Michael R.

AU - Schroeder, Brent J.

AU - Lee, Robert E Citrowske

AU - Narr, Bradly J.

AU - Ribeiro, Tarsila C R

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AU - Sprung, Juraj

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N2 - Background: 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. Methods: 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)]. Results 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. Conclusions: 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.

AB - Background: 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. Methods: 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)]. Results 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. Conclusions: 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.

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KW - Anesthesia: general

KW - Complications: perioperative

KW - Nonalcoholic fatty liver disease

KW - Steatohepatitis

KW - Surgery bariatric

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