CLINICAL RESEARCH NAFLD and Insulin Resistance Do Not Increase the Risk of Postoperative Complications Among Patients Undergoing Bariatric Surgery—A Prospective Analysis Tarsila Ribeireiro & James Swain & Michael Sarr & Michael Kendrick & Florencia Que & Schuyler Sanderson & Anuradha Krishnan & Kimberly Viker & Kymberly Watt & Michael Charlton Published online: 5 October 2010 # Springer Science+Business Media, LLC 2010 Abstract Background Nonalcoholic fatty liver disease (NAFLD) and insulin resistance are common consequences of obesity and are highly prevalent among patients undergoing bariatric surgery. Insulin resistance and NAFLD have been reported to be associated with postoperative complications following major surgery. Methods We prospectively evaluated complications in a cohort of 437 consecutive patients undergoing bariatric surgery. Detailed metabolic profile was obtained prior to surgery, and liver biopsies were taken routinely during surgery. Results Mean age was 47.8 years (20–77), and mean body mass index (BMI) was 48.5 kg/m 2 (32–94). Common co-morbid conditions were metabolic syndrome (79%), obstructive sleep apnea (73%), and hypertension (60%). Seventy-seven percent underwent Roux-en-Y gastric bypass, 15% biliopancreatic diversion with duodenal switch, and 8% adjustable gastric banding. The operative approach was laparoscopic in 81% of patients. Liver histology was normal in 22% of patients. Seventy-eight percent of patients had NAFLD. Nonalcoholic steatohepatitis (NASH) was present in 18%. Advanced fibrosis (stage 3–4) was present in 5%. Complications were observed in 25% of the cohort, the most frequent being infection, occurring in 14%. The wound was the most frequent site of infection (9%). There were no cases of postoperative hepatic decompensation. Reoperation was necessary in 7%. In univariate analysis, the factors associated with complications were male gender (p =0.009), type and approach of surgery (p =0.023 and p =0.0001, respectively), BMI (p =0.000), serum creatinine (p =0.023), and serum albumin (p =0.0001). In multivariate analysis, the indepen- dent factors associated with complications in bariatric surgery were BMI (OR 1.039, 95% CI 1.010–1.068; p = 0.008), surgical approach (OR 2.696, 95% CI 1.547–4.698; p =0.000), and serum albumin (OR 0.416, 95% CI 0.176– 0.978; p =0.044). NASH was not predictive of complications. Conclusions Bariatric surgery is a safe and efficient treatment for obesity. The occurrence of NAFLD or NASH without portal hypertension should not preclude the procedure. Keywords Nonalcoholic fatty liver disease . NAFLD . Nonalcoholic steatohepatitis . Morbid obesity . Bariatric surgery . Hepatic histopathology Background The rising global prevalence of obesity has been well documented. According to the most recent National Health and Nutrition Education Survey (NHANES), two thirds of adults in the USA are overweight or obese, with over 1 million with a BMI greater than 60 kg/m 2 .[1]. Although the overall prevalence of obesity has recently begun to plateau, the prevalences of the most severe classes of obesity are rising This work has been supported by Public Health Service grant NIDDK RO1 DK069757-01 and GCRC RR00585. T. Ribeireiro : A. Krishnan : K. Viker : K. Watt : M. Charlton (*) Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA e-mail: charlton.michael@mayo.edu J. Swain : M. Sarr : M. Kendrick : F. Que Department of Surgery, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA S. Sanderson Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA OBES SURG (2011) 21:310–315 DOI 10.1007/s11695-010-0228-6