Mumtaz Khalid, Lipshultz Hannah, Jalil Sajid, Porter Kyle, Li Na, Kelly Sean G, Conteh Lanla F, Michaels Anthony, Hanje James, Black Sylvester, Hussan Hisham
Department of Internal Medicine, The Ohio State University Wexner Medical Center, 43210, 395 West 12th Avenue, 2nd Floor, Columbus, OH, 43210, USA.
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, 2nd Floor, Columbus, OH, 43210, USA.
Obes Surg. 2020 Sep;30(9):3444-3452. doi: 10.1007/s11695-020-04583-4.
Previous reports suggest an increased mortality in cirrhotic patients undergoing bariatric surgery (BS). With advancements in management of BS, we aim to study the trends, outcomes, and their predictors in patients with cirrhosis undergoing BS.
A retrospective study was performed using the National Database from 2008 to 2013. Outcomes of BS in patients with cirrhosis were studied. In-hospital mortality, length of stay, and cost of care were compared between patients with no cirrhosis (NC), compensated cirrhosis (CC), and decompensated cirrhosis (DC). Multivariable logistic regression analysis was performed to study the predictors of mortality.
Of the 558,017 admissions of patients who underwent BS during the study period, 3086 (0.55%) had CC and 103 (0.02%) had DC. An upward trend of vertical sleeve gastrectomy (VSG) utilization was seen during the study period. On multivariate analysis, mortality in CC was comparable with those in NC (aOR 1.88; CI 0.65-5.46); however, it was higher in DC (aOR 83.8; CI 19.3-363.8). Other predictors of mortality were older age (aOR 1.06; CI 1.04-1.08), male (aOR 2.59; CI 1.76-3.81), Medicare insurance (aOR 1.93; CI 1.24-3.01), lower income (aORs 0.44 to 0.55 for 2nd to 4th income quartile vs. 1st quartile), > 3 Elixhauser Comorbidity Index (aOR 5.30; CI 3.45-8.15), undergoing Roux-en-Y gastric bypass as opposed to VSG (aOR 3.90; CI 1.79-8.48), and centers performing < 50 BS per year (aOR 5.25; CI 3.38-8.15). Length of stay and hospital cost were also significantly higher in patients with cirrhosis as compared with those with NC.
Patients with compensated cirrhosis can be considered for bariatric surgery. However, careful selection of patients, procedure type, and volume of surgical center is integral in improving outcomes and healthcare utilization in patients with cirrhosis undergoing BS.
既往报告提示，接受减重手术（BS）的肝硬化患者死亡率升高。随着减重手术管理的进展，我们旨在研究接受减重手术的肝硬化患者的趋势、结局及其预测因素。
利用2008年至2013年的国家数据库进行一项回顾性研究。研究了肝硬化患者的减重手术结局。比较了无肝硬化（NC）、代偿期肝硬化（CC）和失代偿期肝硬化（DC）患者的住院死亡率、住院时间和护理费用。进行多变量逻辑回归分析以研究死亡率的预测因素。
在研究期间接受减重手术的558,017例患者中，3086例（0.55%）患有代偿期肝硬化，103例（0.02%）患有失代偿期肝硬化。在研究期间观察到垂直袖状胃切除术（VSG）的使用呈上升趋势。多变量分析显示，代偿期肝硬化患者的死亡率与无肝硬化患者相当（调整后比值比[aOR]1.88；可信区间[CI]0.65 - 5.46）；然而，失代偿期肝硬化患者的死亡率更高（aOR 83.8；CI 19.3 - 363.8）。其他死亡率预测因素包括年龄较大（aOR 1.06；CI 1.04 - 1.08）、男性（aOR 2.59；CI 1.76 - 3.81）、医疗保险（aOR 1.93；CI 1.24 - 3.01）收入较低（第二至第四收入四分位数与第一四分位数相比，aOR为0.44至0.55）、埃利克斯豪泽合并症指数>3（aOR 5.30；CI 3.45 - 8.15）、接受Roux-en-Y胃旁路手术而非垂直袖状胃切除术（aOR 3.90；CI 1.79 - 8.48）以及每年进行减重手术少于50例的中心（aOR 5.25；CI 3.38 - 8.15）。与无肝硬化患者相比，肝硬化患者的住院时间和住院费用也显著更高。
代偿期肝硬化患者可考虑接受减重手术。然而，仔细选择患者、手术类型和手术中心的手术量对于改善接受减重手术的肝硬化患者的结局和医疗资源利用至关重要。
