Progressive Rise in Hepatic Steatosis and Fibrosis with Longer Time Since Cholecystectomy: Findings from a Nationally Representative Survey

Background Cholecystectomy is a common surgical procedure, yet its long-term metabolic consequences on liver health remain poorly understood. The temporal association between time since cholecystectomy and hepatic steatosis and fibrosis was evaluated using data from a nationally representative US population. Methods We analyzed data from the 2017~2020 National Health and Nutrition Examination Survey (NHANES) cycles, focusing on participants with available data on vibration-controlled transient elastography (VCTE), liver stiffness measurements (LSM), controlled attenuation parameter (CAP), and the FIB-4 index. Adults aged ≥20 years without viral hepatitis, malignancy, or liver disease were included. Cholecystectomy exposure was categorized by time since surgery: no cholecystectomy, 0~5 years, 6~10 years, and >10 years. Weighted linear and logistic regression models assessed associations with CAP, LSM, and FIB-4, adjusting for demographic, metabolic, and lifestyle factors. Sensitivity analyses using inverse probability of treatment weighting (IPTW) were conducted to assess robustness. Results Among 6,246 eligible adults, cholecystectomy was independently associated with increased odds of hepatic steatosis (CAP > 248 dB/m), particularly with longer postoperative durations (OR: 1.141 for >10 years, p10 years = 0.179, p