Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Clin Gastroenterol Hepatol. 2011 Oct;9(10):897-901. doi: 10.1016/j.cgh.2011.07.007. Epub 2011 Jul 23.
BACKGROUND & AIMS: The prevalence of nonalcoholic fatty liver disease and ensuing cirrhosis is expected to increase as a result of the obesity epidemic. These trends might increase the number of bariatric surgeries among patients with cirrhosis. We sought to assess the impact of cirrhosis on perioperative mortality after bariatric procedures.
Data on patients who underwent bariatric surgery in the United States between 1998 and 2007 were extracted from the Nationwide Inpatient Sample. In-hospital mortality and length of stay were compared for patients with no cirrhosis, compensated cirrhosis, and decompensated cirrhosis.
Patients without cirrhosis had lower mortality rates than those with compensated and decompensated cirrhosis (0.3% vs 0.9% and 16.3%, respectively, P = .0002). After adjusting for covariates, the adjusted odds ratio of mortality among compensated and decompensated cirrhotic patients compared with noncirrhotic patients was 2.17 (95% confidence interval, 1.03-4.55) and 21.2 (95% confidence interval, 5.39-82.9), respectively. Mortality increased with volume of surgery among centers; those with more than 100 surgeries per year had the lowest mortality rates, compared with those with 50 to 100 surgeries per year and fewer than 50 surgeries per year (0.2% vs 0.4% and 0.7%, respectively; P < .0001). The average length of stay was longer for patients with decompensated and compensated cirrhosis, compared with patients without liver disease (6.7 and 4.4 d vs 3.2 d, respectively; P = .0001 and P = .03).
Bariatric surgery in patients with cirrhosis should be performed while liver disease is well compensated. Patients with cirrhosis should undergo surgery at centers that perform large numbers of these procedures.
随着肥胖症的流行，非酒精性脂肪性肝病及其相关肝硬化的发病率预计将会增加。这些趋势可能会增加肝硬化患者的减重手术数量。我们旨在评估肝硬化对减重手术后围手术期死亡率的影响。
从 1998 年至 2007 年全美住院患者样本中提取在美国接受减重手术的患者数据。比较无肝硬化、代偿性肝硬化和失代偿性肝硬化患者的住院死亡率和住院时间。
无肝硬化患者的死亡率低于代偿性和失代偿性肝硬化患者（分别为 0.3%、0.9%和 16.3%，P =.0002）。调整协变量后，与非肝硬化患者相比，代偿性和失代偿性肝硬化患者的死亡调整比值比分别为 2.17（95%置信区间，1.03-4.55）和 21.2（95%置信区间，5.39-82.9）。手术量与中心死亡率相关；每年手术量超过 100 例的中心死亡率最低，其次是每年手术量 50-100 例和每年手术量少于 50 例的中心（分别为 0.2%、0.4%和 0.7%；P <.0001）。与无肝病患者相比，失代偿性和代偿性肝硬化患者的平均住院时间更长（分别为 6.7 和 4.4 天和 3.2 天；P =.0001 和 P =.03）。
肝硬化患者的减重手术应在肝功能良好代偿时进行。肝硬化患者应在进行大量此类手术的中心进行手术。
