P1496 - Impact of Bariatric Surgery Type on Mortality and Liver Outcomes in Morbidly Obese Patients with NAFLD: A Propensity Score-Matched Cohort Study

Om Patel, MD¹, Abdallah Hussein, MD², Jashanveer S. Singh Johal, MD¹, Yecheskel Schneider, MD, MS³, Islam Rajab, MD⁴, Elaf Khatib, MS⁵
1Virtua Health System / Virtua Medical Group, Camden, NJ; 2Virtua Our Lady of Lourdes Hospital, Camden, NJ; 3Virtua Health System, Moorestown, NJ; 4St. Joseph's University Medical Center, Paterson, NJ; 5Thomas Jefferson University, Philadelphia, PA

Introduction: The role of bariatric surgery in improving outcomes among patients with nonalcoholic fatty liver disease (NAFLD) remains an area of active investigation. While both sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) improve metabolic parameters, comparative risks of hepatic and all-cause complications are not well established. This study assessed mortality and hepatic fibrosis-related outcomes among matched cohorts undergoing SG or RYGB.

Methods: Adult patients (≥18 years) with body mass index (BMI) ≥35 kg/m² and a diagnosis of NAFLD or nonalcoholic steatohepatitis (NASH) were identified. Two cohorts—RYGB and sleeve gastrectomy—were formed based on procedure codes. Propensity score matching (1:1) was applied to balance demographic and clinical variables, yielding 13,566 patients in each group. Primary outcomes included liver-related complications and all-cause mortality. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were reported.

Results: After propensity score matching, 13,566 patients were included in each group. The overall cohort's mean ± SD age was 45.1 ± 11.4 years for the RYGB group and 45.3 ± 11.7 years for the sleeve group, with 77.1% and 77.0% female, respectively. The majority of patients were White (74.9% in the RYGB group vs. 74.9% in the sleeve group) and not Hispanic or Latino (67.4% vs. 66.0%). Matching achieved balance across cohorts (standardized difference < 0.01). The risk of liver-related complications was significantly lower in the RYGB group compared to the sleeve group (9.7% vs. 10.9%; OR: 0.876, 95% CI: 0.81–0.947; p = 0.0009). However, mortality was significantly higher in the RYGB group than in the sleeve group (5.6% vs. 3.3%; OR: 1.7, 95% CI: 1.509–1.914; p < 0.0001).

Discussion: Among morbidly obese patients with NAFLD, RYGB was associated with a modest reduction in liver-related complications compared to SG, but at the cost of significantly increased all-cause mortality. These findings highlight the importance of individualized risk-benefit analysis when selecting a bariatric procedure in patients with metabolic liver disease.

Disclosures:
Om Patel indicated no relevant financial relationships.
Abdallah Hussein indicated no relevant financial relationships.
Jashanveer Singh Johal indicated no relevant financial relationships.
Yecheskel Schneider indicated no relevant financial relationships.
Islam Rajab indicated no relevant financial relationships.
Elaf Khatib indicated no relevant financial relationships.

Om Patel, MD¹, Abdallah Hussein, MD², Jashanveer S. Singh Johal, MD¹, Yecheskel Schneider, MD, MS³, Islam Rajab, MD⁴, Elaf Khatib, MS⁵. P1496 - Impact of Bariatric Surgery Type on Mortality and Liver Outcomes in Morbidly Obese Patients with NAFLD: A Propensity Score-Matched Cohort Study, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.