P4881 - Gender Disparities in the Impact of Bariatric Surgery in Metabolic Associated Steatohepatitis Disease (MASLD) Patients: Propensity Matched Analysis of a Large Multi-Institutional Cohort

Award: Presidential Poster Award

Amna Iqbal, MD¹, Waqas Rasheed, MD², Hassam Ali, MD³, Umar Hayat, MD⁴, Zohaib Ahmed, MD¹, Aqsa Khan, MD⁵, Dushyant S. Dahiya, MD⁶, Priyanka Ahuja, MD⁷, Rehmat Ullah Awan, MD⁸, Shailendra Singh, MD⁸, Ali Nawras, MD^1
1University of Toledo Medical Center, Toledo, OH; ²University of Kentucky, Lexington, KY; ³ECU Health Medical Center, Greenville, NC; ⁴Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; ⁵Parkview Health Center, Fort Wayne, IN; ⁶The University of Kansas School of Medicine, Kansas City, KS; ⁷University of Toledo, Toledo, OH; ⁸West Virginia University, Morgantown, WV

Introduction: Metabolic Associated Steatohepatitis Disease (MASLD) formerly non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide owing to increased rates of obesity and Western diet. Lifestyle modifications with weight loss and physical activity can reduce and reverse liver injury in patients with MASLD. With advances in bariatric surgery procedures, it is paramount to evaluate bariatric surgery outcomes on MASLD disease burden.

Methods: The multi-institutional research network TriNetX US Collaborative Network was used to identify patients with adult MASLD patients (aged 18 or above) who underwent bariatric surgery. After crude analysis, a propensity score matched (PSM) analysis was performed using demographic variables, history of obesity, mood disorders, prediabetes and other comorbidities as covariates to control for confounders.  A two-sided P-value ≤ 0.05 was set as a threshold for statistical significance. 

Results: A total of 28,812 female and 7,905 male MASLD patients who underwent bariatric surgery were identified (Table 1). At baseline, female patients were younger, had lower rates of obesity, Hypertension (HTN), Cerebral vascular accident (CVA), peripheral arterial disease (PAD), mood disorders and socioeconomical issues. All study characteristics were well balanced in the propensity matched cohorts. 




In the matched cohort there was a 31.7% lower association of all-cause mortality in females compared to males (4.27% vs 6.13%; OR: 0.68, CI: 0.59-0.78). There was no significant association of advanced hepatic fibrosis between two genders (0.16% vs 0.24%; OR: 0.684, CI: 0.337-1.385). There was a 36.1% lower association of hepatic encephalopathy (0.77% vs 1.20%; OR: 0.63, CI: 0.46-0.88), 35.8% lower association of spontaneous bacterial peritonitis (SBP) (0.73% vs 1.14%; OR: 0.64, CI: 0.46-0.89), and 49.5% lower association of esophageal varices (0.96% vs 1.88%; OR: 0.50, CI: 0.38-0.66) in females compared to male patients, respectively. The diabetes mellitus rate was similar between males and females (10.84% vs 11.47%; OR: 0.91, CI: 0.82-1.01) (Figure 1)

Discussion: Bariatric surgery in females patients with MASLD is associated with low all-cause mortality, hepatic encephalopathy, SBP, esophageal varices compared to males. Multidisciplinary approach with hepatology, nutrition, surgical and advanced endoscopy teams is warranted to improve clinical outcomes.



Disclosures:


Amna Iqbal, MD¹, Waqas Rasheed, MD², Hassam Ali, MD³, Umar Hayat, MD⁴, Zohaib Ahmed, MD¹, Aqsa Khan, MD⁵, Dushyant S. Dahiya, MD⁶, Priyanka Ahuja, MD⁷, Rehmat Ullah Awan, MD⁸, Shailendra Singh, MD⁸, Ali Nawras, MD¹. P4881 - Gender Disparities in the Impact of Bariatric Surgery in Metabolic Associated Steatohepatitis Disease (MASLD) Patients: Propensity Matched Analysis of a Large Multi-Institutional Cohort, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.