Impact of multidisciplinary steatotic liver disease management on bariatric surgery referral and clinical outcomes: A retrospective cohort study

BACKGROUND Lifestyle modifications aimed at weight loss are key to improving metabolic dysfunction-associated steatotic liver disease (MASLD); however, achieving substantial and sustained weight loss through non-surgical approaches may be difficult for some patients. Bariatric surgery should be considered as a therapeutic option in select patients with MASLD, but the national referral rate for eligible patients is low (< 1%). AIM To examine referral rates and one-year outcomes among adults with MASLD in a multidisciplinary clinic integrating hepatology and obesity medicine. METHODS We performed a retrospective cohort study of 965 patients seen in a MASLD-specific clinic over a three-year period (2018-2022). Patients were categorized as bariatric surgery eligible or non-eligible based on standard referral criteria. We assessed bariatric surgery referral rates, weight, and liver-related outcomes, including change in nonalcoholic fatty liver disease fibrosis score. Categorical variables were compared with χ 2 tests, and continuous variables were analyzed with two-tailed t -tests. P value < 0.05 was considered significant. RESULTS Among 491 patients eligible for bariatric surgery, 127 patients (26%) were referred for surgical evaluation, with 31 patients (24%) ultimately undergoing bariatric surgery (21 sleeve gastrectomy and 10 Roux-en-Y gastric bypass). The remaining 96 patients continued with medication and/or lifestyle management. Individuals who underwent bariatric surgery achieved greater one-year total body weight loss than those who utilized medication and/or lifestyle management alone (20.6% vs 2.5%, P < 0.001). Average nonalcoholic fatty liver disease fibrosis score at one year was -0.91 in surgery patients vs -0.008 in non-surgery patients (P = 0.005). CONCLUSION Integration of weight management with hepatology care in patients with MASLD resulted in bariatric surgery referral rates that substantially exceed the national average, leading to improved weight and liver-related outcomes.