# Racial and Gender Disparities in the Occurrence and Outcomes of Alcohol-Associated Hepatitis in Hospitalized Patients With Prior Bariatric Surgery

## TL;DR

Bariatric surgery may protect against severe outcomes in alcohol-related liver disease, with higher hospitalization rates among women and Black patients.

## Contribution

This study identifies a potential protective effect of bariatric surgery on alcohol-associated hepatitis outcomes and highlights racial and gender disparities in hospitalization rates.

## Key findings

- Bariatric surgery was linked to lower in-hospital mortality and complications in patients with alcohol-associated hepatitis.
- Female and Black patients had higher odds of AAH hospitalization following bariatric surgery compared to males and White patients.
- No differences in outcomes were observed across sex or race after bariatric surgery.

## Abstract

Background

There is an increased risk of alcohol use disorder post-bariatric surgery. The impact of bariatric surgery on the outcomes of alcohol-associated hepatitis (AAH) remains unclear. Hence, we aimed to evaluate whether a history of bariatric surgery influences in-hospital outcomes of AAH and whether these associations vary by sex or race.

Methodology

We conducted a retrospective, cross-sectional study using the 2016-2020 National Inpatient Sample to identify adult hospitalizations with AAH and bariatric surgery diagnoses. We performed a 1:1 propensity score matching. Matching variables included baseline characteristics (age, sex, primary payer source, race, etc.), clinical comorbidities (diabetes, hypertension, etc.), and outcomes (in-hospital mortality, acute kidney injury, heart failure, major adverse cardiovascular event, length of stay, death, etc). Multivariable regression was performed to compare in-hospital mortality, hepatic decompensation, and other complications. Subgroup analyses were used to assess disparities by sex and race.

Results

Among 100,910 AAH admissions, 2.3% had a history of bariatric surgery. After matching, bariatric surgery was associated with significantly lower odds of in-hospital mortality (adjusted odds ratio (aOR) = 0.55, 95% confidence interval (CI) = 0.35-0.89), hepatic decompensation (aOR = 0.58, 95% CI = 0.44-0.77), acute kidney injury (aOR = 0.72, 95% CI = 0.60-0.87), and acute respiratory distress syndrome (aOR = 0.64, 95% CI = 0.46-0.91). Female and Black patients had statistically higher likelihood of AAH hospitalization following bariatric surgery compared to males (aOR = 6.90, 95% CI = 6.15-7.74) and White patients (aOR = 1.18, 95% CI = 1.04-1.35), respectively. No differences in outcomes were observed across sex or race.

Conclusions

Among AAH patients, prior bariatric surgery was associated with significantly improved in-hospital outcomes and may suggest a potential protective effect of metabolic optimization.