Metabolic bariatric surgery is associated with reduced adverse hepatic and extrahepatic outcomes, and lower all-cause mortality, in patients with steatotic liver disease.

[AIM] Metabolic bariatric surgery (MBS) improves histological endpoints in steatotic liver disease (SLD), but data on longer-term clinical outcomes in this population are scarce. Here, we assessed the impact of MBS on hepatic and extrahepatic morbidity and mortality in individuals with SLD.

[METHODS] Patients with SLD, with/without a history of MBS (MBS/no-MBS cohorts, respectively) between 01/01/2004 and 31/10/2019, were identified using the TriNetX platform. Cohorts were balanced with propensity score matching (PSM). Maximum follow-up was set to 5 years. The primary outcome was a composite of major adverse liver outcomes (MALO): cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver transplant. Secondary outcomes included major cardiovascular (MACE) and kidney (MAKE) adverse events, obesity-associated cancers, and all-cause mortality (ACM). We performed sub-group analyses according to sex, MBS type, and risk factors (BMI ≥50 kg/m and type 2 diabetes (T2D)).

[RESULTS] We identified 15,262 and 540,031 patients (for the MBS and no-MBS cohorts, respectively); 14,970 patients/cohort after PSM (mean age: 46.7 vs. 47.4; female: 74.3% vs. 75.7%; mean follow-up, 4.1 years). MBS was associated with reduced HR of MALO (0.84, 95% CI 0.75-0.95), MACE (0.52, CI 0.47-0.57), MAKE (0.54, CI 0.41-0.72), obesity-related cancers (0.58, CI 0.50-0.67), and ACM (0.49, 0.43-0.56). In subgroup analyses, MBS was associated with reduced HR of MALO, MACE, MAKE, obesity-related cancers, and ACM in females, patients with T2D, BMI > 50 kg/m and irrespective of surgery type.

[CONCLUSION] In patients with SLD, MBS is associated with significant reductions in the rates of adverse hepatic and extrahepatic outcomes and all-cause mortality over 4 years' follow-up.