title: Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery.
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.
authors.affiliation: Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.forename: James M
authors.initials: JM
authors.lastname: Swain
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.forename: Michael R
authors.initials: MR
authors.lastname: Charlton
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Schroeder
authors.forename: Robert E Citrowske
authors.initials: RE
authors.lastname: Lee
authors.forename: Bradly J
authors.initials: BJ
authors.lastname: Narr
authors.forename: Tarsila C R
authors.initials: TC
authors.lastname: Ribeiro
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies