Abstract
Background
As the obesity epidemic worsens, the prevalence of fatty liver disease has increased.
However, minimal data exist on the impact of combined fatty liver and metabolic syndrome
on hepatectomy outcomes. Therefore, the aim of this analysis is to measure the outcomes
of patients who do and do not have a fatty liver undergoing hepatectomy in the presence
and absence of the metabolic syndrome.
Methods
Patients with fatty and normal livers undergoing major hepatectomy (≥3 segments) were
identified in the 2014 to 2018 American College of Surgeon National Surgical Quality
Improvement Program database. Patients undergoing partial hepatectomy and those with
missing liver texture data were excluded. Propensity matching was used and adjusted
for multiple variables. A subgroup analysis stratified by the metabolic syndrome (body
mass index ≥30 kg/m2, hypertension and diabetes) was performed. Demographics and outcomes were compared
by χ2 and Mann-Whitney tests.
Results
Of 2,927 hepatectomies, 30% of patients (N = 863) had a fatty liver. The median body mass index was 28.6, and the metabolic
syndrome was present in 6.3% of patients (N = 184). After propensity matching, 863 patients with fatty and 863 with normal livers
were compared. Multiple outcomes were significantly worse in patients with fatty livers
(P <.05), including serious morbidity (32% vs 24%), postoperative invasive biliary procedures
(15% vs 10%), organ space infections (11% vs 7.8%), and pulmonary complications. Patients
with fatty livers and the metabolic syndrome had significantly increased postoperative
cardiac arrests, pulmonary embolisms, and mortality (P < .05).
Conclusion
Fatty liver disease is associated with significantly worse outcomes after major hepatectomy.
The metabolic syndrome confers an increased risk of postoperative mortality.
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Article info
Publication history
Published online: December 23, 2020
Accepted:
November 17,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
