Association of Bariatric Surgery With Major Adverse Liver and Cardiovascular Outcomes in Patients With Biopsy-Proven Nonalcoholic Steatohepatitis
Authors' conclusion
Among patients with NASH and obesity, bariatric surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident major adverse liver outcomes and MACE.
Study context
- Population
- Adults with obesity and biopsy-proven fibrotic nonalcoholic steatohepatitis (NASH) (fibrosis stages 1–3) without cirrhosis, US health system, 2004–2016median follow-up 7 years
- Participants
- 1,158 adults
- Exposure
- Bariatric surgery vs nonsurgical care
- Bariatric surgeryn = 650
- Nonsurgical controln = 508reference
- Outcome
- Major adverse liver outcomes (progression to clinical or histological cirrhosis, hepatocellular carcinoma, liver transplantation, or liver-related mortality) and MACE (coronary artery events, cerebrovascular events, HF, or CV death)
- Follow-up
- 10 years
Methodological detailsoverlap weighting, single US health system
- Overlap weighting
- Single US health system
Main finding
As reported in the abstract
Bariatric surgery
- Major adverse liver outcomes, cumulative incidence
- 2.3% (95% CI, 0%-4.6%)
- Major adverse cardiovascular events (MACE), cumulative incidence
- 8.5% (95% CI, 5.5%-11.4%)
- Major adverse liver outcomes, events (unweighted)
- 5
- MACE, events (unweighted)
- 39
Nonsurgical control
- Major adverse liver outcomes, cumulative incidence
- 9.6% (95% CI, 6.1%-12.9%)
- MACE, cumulative incidence
- 15.7% (95% CI, 11.3%-19.8%)
- Major adverse liver outcomes, events (unweighted)
- 40
- MACE, events (unweighted)
- 60
Major adverse liver outcomes, cumulative incidence
Bariatric surgery2.3% (95% CI, 0%-4.6%)
Nonsurgical control9.6% (95% CI, 6.1%-12.9%)
Major adverse cardiovascular events (MACE), cumulative incidence
Bariatric surgery8.5% (95% CI, 5.5%-11.4%)
Nonsurgical control15.7% (95% CI, 11.3%-19.8%)
Major adverse liver outcomes, events (unweighted)
Bariatric surgery5
Nonsurgical control40
MACE, events (unweighted)
Bariatric surgery39
Nonsurgical control60
Adjusted absolute risk difference (95% CI)
Nonsurgical controlvs Bariatric surgerymajor adverse liver outcomes
12.4%(5.7%–19.7%)
Nonsurgical controlvs Bariatric surgeryMACE
13.9%(5.9%–21.9%)
Adjusted hazard ratio (95% CI)P value
Bariatric surgeryvs Nonsurgical controlmajor adverse liver outcomes
0.12(0.02–0.63)
P = 0.01Bariatric surgeryvs Nonsurgical controlMACE
0.30(0.12–0.72)
P = 0.007Observational data: associations, not effects.
Further findings
- Death from surgical complications (gastrointestinal leak n = 2, respiratory failure n = 2) · first year after surgery — Bariatric surgery
- 0.6%
Original publication
Association of Bariatric Surgery With Major Adverse Liver and Cardiovascular Outcomes in Patients With Biopsy-Proven Nonalcoholic Steatohepatitis. JAMA. Published 23 November 2021. doi:10.
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