Impact of preoperative liver disease diagnosis on postoperative outcomes in bariatric surgery

Document Type

Article

Publication Date

10-30-2025

Publication Title

Surgery for Obesity and Related Diseases

Abstract

BACKGROUND: Obesity increases the risk of metabolic-associated steatotic liver disease (MASLD), and metabolic and bariatric surgery (MBS) mitigates progression to severe and end-stage liver disease (LD). Preoperative LD was added as a new variable for the 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, allowing for analysis of this variable on perioperative and postoperative outcomes. OBJECTIVE: To examine the impact of preoperative LD diagnosis on 30-day outcomes following MBS and quantify intraoperative liver biopsy frequency. SETTING: MBSAQIP, 2023. METHODS: A total of 217,952 cases (24,240 with LD; 193,712 without LD) were analyzed to compare operative length, length of stay (LOS), infectious complications, serious complications, major adverse cardiovascular events (MACE), and mortality. Chi-square and Wilcoxon rank-sum tests were used, and propensity matching was performed based on age, sex, race, body mass index, and preoperative comorbidities. RESULTS: Patients with LD had a slight increase in operative length (99.6 vs. 92.0 min; P < .0001) and were more likely to experience prolonged LOS (>5 days: .84% vs. .67%; P < .05). Rates of infectious complications (1.86% vs. 1.40%; P < .0001) and serious complications (1.65% vs. 1.31%; P < .01) were higher among those with LD. There were no differences in 30-day mortality (.08% vs. .11%; p = NS) or MACE (MACE: .10% vs. .07%; p = NS) between groups. Only 3.5% of cases included intraoperative liver biopsy. CONCLUSION: Patients with LD experienced higher rates of postoperative infections and serious complications, as well as prolonged LOS, than those without LD. These findings highlight the importance of preoperative LD screening in bariatric surgery patients.

PubMed ID

41260959

Rights

© 2025 American Society for Metabolic and Bariatric Surgery

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