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

Abstract 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 2 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 2 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.