Impact of multidisciplinary steatotic liver disease management on bariatric surgery referral and clinical outcomes: A retrospective cohort study

Table 1 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program weight-loss calculator outcomes

MBSAQIP weight-loss calculator outcomes	Predicted	Actual	P value
1 year final BMI (kg/m2, mean ± SD)	33.1 ± 4.3	35.6 ± 7.4	0.12
1 year weight loss (kg, mean ± SE)	30.3 ± 1.7	25.4 ± 2.8	0.13
1 year TBWL (%, mean ± SE)	24.5 ± 1.1	21.1 ± 1.8	0.13

MBSAQIP: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program; BMI: Body mass index; TBWL: Total body weight loss.

Table 2 Bariatric surgery eligibility criteria

Bariatric surgery eligibility criteria
BMI ≥ 35 kg/m2 with at least one obesity-associated comorbidity
Hypertension
Type II diabetes mellitus
Obstructive sleep apnea
BMI ≥ 40 kg/m2

BMI: Body mass index.

Table 3 Demographic characteristics of patients with metabolic dysfunction-associated steatotic liver disease categorized by bariatric surgery eligibility, n (%)

Patient characteristics		BSE	BSNE	P value
Number of patients	n = 965	491	474
Sex	Male	173 (35)	225 (47)	0.0001
	Female	318 (65)	249 (53)
Age in years, mean ± SD		50.2 ± 13	56.4 ± 12	< 0.0001
Race	White	372 (76)	391 (82)	< 0.0001
	Black	53 (10)	20 (4)
	Asian	3 (1)	16 (3)
	Other/declined	63 (13)	50 (11)
Ethnicity1	Hispanic	71 (14)	57 (12)	0.3
	Non-Hispanic	419 (85)	417 (88)
Insurance status	Uninsured	9 (2)	11 (2)	< 0.0001
	Medicaid	114 (23)	61 (13)
	Medicare	97 (20)	137 (29)
	Private	271 (55)	265 (56)
Median household income by zip code	< $50000	81 (16)	66 (14)	< 0.0001
	$50000-$100000	319 (65)	240 (51)
	> $100000	91 (19)	168 (35)
Trialed anti-obesity medication	Lifetime	255 (52)	234 (49)
	Since FLDP	222 (45)	209 (44)
Body mass index (kg/m2), mean ± SD	At initial visit	41.6 ± 12	29.6 ± 3.7	< 0.0001
Comorbidities	Diabetes	276 (56)	171 (36)
	Chronic liver disease2	57 (12)	91 (19)
	Liver cancer	11 (2.2)	9 (1.9)

¹One subject declined to provide ethnicity information.

²Composite variable for non-neoplastic etiologies, including viral, toxin/drug-induced, genetic, metabolic, and autoimmune.

Continuous variables are presented as mean ± SD and compared using unpaired t-test. Categorical variables are presented as n (%) and compared using the χ² test. BSE: Bariatric surgery eligible; BSNE: Bariatric surgery non-eligible; FLDP: Fatty liver disease program.

Table 4 Demographic and surgical characteristics of bariatric surgery eligible patients who were referred for surgery, n (%)

Patient characteristics		(+) Surgery	(-) Surgery	P value
Number of patients	n = 127	31	96
Sex	Male	6 (20)	32 (33)	0.14
	Female	25 (80)	64 (67)
Age in years, mean ± SD		49 ± 10.5	52 ± 13.1	0.248
Race	White	21 (68)	76 (79)	0.236
	Black	4 (13)	8 (8)
	Asian	1 (3)	0 (0)
	Other/declined	5 (16)	12 (13)
Ethnicity	Hispanic	6 (19)	20 (21)	0.86
	Non-Hispanic	25 (81)	76 (79)
Insurance status	Uninsured	0 (0)	0 (0)	0.035
	Medicaid	14 (46)	25 (26)
	Medicare	2 (6)	24 (25)
	Private	15 (48)	46 (49)
Median household income by zip code	< $50000	7 (23)	18 (19)	0.74
	$50000-$100000	19 (61)	66 (69)
	> $100000	5 (16)	12 (12)
Interventions and outcomes
Trialed anti-obesity medication	Lifetime	13 (42)	32 (33)	0.59
	Trialed since first FLDP visit	8 (26)	26 (27)
Surgery type	RYGB	10 (32)
	SG	21 (68)
Non-surgical weight loss method	Medication and lifestyle		41 (43)
	Lifestyle only		55 (57)
Nutrition referral	Since first FLDP visit	15 (48)	62 (65)
Mean BMI reduction (kg/m2), mean ± SD	RYGB	8.3 ± 5.4	1.3 ± 3.9	< 0.0001

Categorical variables compared using the χ² test. FLDP: Fatty liver disease program; RYGB: Roux-en-Y gastric bypass; SG: Sleeve gastrectomy; BMI: Body mass index.

Table 5 Outcomes in surgical vs non-surgical patients who were referred for bariatric surgery (mean ± SD, n/total n)

Patient characteristics		(+) Surgery	(-) Surgery	P value
Mean BMI (kg/m2)	RYGB	8.3 ± 5.4, 10/10	1.3 ± 3.9, 89/96	< 0.0001
	SG	9.1 ± 6.3, 21/21		< 0.0001
Mean weight reduction	RYGB	26.3 ± 10.3, 10/10	4.1 ± 10.2, 89/96	< 0.0001
	SG	27.7 ± 17.9, 21/21		< 0.0001
TBWL (%, mean ± SE, n/total n)	RYGB	20 ± 2.7, 10/10	2.5 ± 0.81, 89/96	< 0.0001
	SG	21 ± 2.1, 21/21		< 0.0001
∆NAFLD fibrosis score ± n/total n		-0.91 ± (22/31)	-0.008 ± (62/96)	0.005
∆FIB-4 score ± n/total n		-0.12 ± (30/31)	-0.055 ± (40/96)	0.58

Comparisons between groups analyzed using Welch’s unpaired t-test. BMI: Body mass index; RYGB: Roux-en-Y gastric bypass; SG: Sleeve gastrectomy; TBWL: Total body weight loss; NAFLD: Non-alcoholic fatty liver disease; FIB-4: Fibrosis-4.