NAME OF INSTITUTE : KAMDAR COLLEGE OF NURSING

COURSE : M.Sc. NURSING FIRST YEAR

SUBJECT : NURSING EDUCATION

TOPIC : JOURNAL PRESENTATION

TEACHING METHOD : TEACHING CUM DISCUSSION

A.V. AIDS USED : PPT AND BLACK BOARD

SUBMITTED TO : Mrs. MINAXI MADAM

SUBMITTED BY : Ms. VINA SOLANKI

 OBJECTIVES

GENERAL OBJECTIVE:
At the end of my journal presentation, all learners will get
knowledge about “Bariatric Surgery is associated with Decreased Progression
Of Non Alcoholic Fatty Liver Disease To Cirrhosis”

SPECIFIC OBJECTIVE:
 To explain the original Article
 To discuss about the clinical Question
 To Introduce the journal article
 To explain the methodology
 To present the statistical Analysis
 ORIGIONAL ARTICLE

 Bariatric Surgery is associated with Decreased Progression Of

Non Alcoholic Fatty Liver Disease To Cirrhosis
A Retrospective Cohort Analysis

 Keith M. Wirth, MD, Adam C. Sheka, MD, SCott Kizy, MD, Ryan Irey, MA,
MS, Ashley Benner, MPH, Gretchen Sieger, BA, Gyorgy Simon, PhD, Sisi
Ma, PhD, John Lake, MD, Constantin Aliferis, MD, MS, PhD, Z Daniel
Lesile, MD, Scheloma Marmor, PhD, MPH, and Sayeed Ikramuddin, MD,
MHA

 Annals Of Surgery, March 2020

CLINICAL QUESTION
Can Bariatric surgery prevent or halt progression to Cirrhosis

80% of patients undergoing Bariatric have NAFLD

20% of NAFLD patients are candidate for Bariatric.

 INTRODUCTION

 NAFLD has become most common cause of Chronic Liver Disease in west
and 2nd most common indication for Liver Transplant.
 NAFLD is accumulation of triglycerides within hepatocytes.
 NAFLD is a spectrum of disease from simple steatosis to non alcoholic
steatohepatitis (NASH) which can progress to Cirrhosis and HCC.
 Pathologically this changes are indistinguishable from Alcoholic Fatty Liver
Disease can only be made in the absence of significant alcohol use.
 Bariatric Surgery is a surgery of alimentary tract for obesity
 Current indications:
 BMI > 40 kg/m2
 BMI > 35 kg/m2 with comorbidities
o T2DM, Hypertention, OSA, Lipid abnormalities,
Osteoarthritis
 NAFLD is currently not an universal indication for bariatric surgery in any
BMI group

METHODOLOGY
 Data Collection:
 Insurance database
 13 year time period (2003-2015)
 Using ICD and CTP codes (ICD 9, ICD 10 with sensitivity analysis?)

 Population:
 Patients with NAFLD
 Aged 18-67 years
 Patients who were having indications for bariatric surgery based on co
morbidities
 Patients who were enrolled in OLDW – OptumLabs Data Warehouse 2 years
before and after diagnosis of NAFLD

 Exclusion Criteria:
 Diagnosis of Cirrhosis within 1 year of NAFLD
 Diagnosis of Cirrhosis before undergoing Bariatric procedure
 Patients who underwent previous acid suppression procedure
 Patients who were having contraindications for Bariatric Surgery
 Intervention:
 Sleeve Gastrectomy
 Roux en Y Gastric Bypass
 Mini Gastric Bypass
 SADI-S
Study has included all procedure as one and doesn’t differentiate among them

 Outcome:

Outcome was measured as development of Cirrhosis

Median follow-up: 32.3 months for Bariatric surgery group

31.3 months for non surgical controls

STATISTICAL ANALYSIS
 A Cox proportional hazards model was used to evaluate the impact of bariatric
surgery on time to cirrhosis and effect of covariates on development of
Cirrhosis
 The association between bariatric surgery and cirrhosis free survival was
evaluated using the Kaplan Meir method.
 A significance level of 0.05 was used for all analysis.

SENSITIVITY ANALYSIS
 Expansion of time period criteria to include ICD-10 codes (January 2003 -
April 2019)
 Separate coding for NASH in ICD – 10

12.6% In surgical group

7.3 In non surgical group

 SUMMARIZATION

 Original Article
 Clinical Question
 Introduction
 Methodology
 Statistical Analysis
 Sensitivity Analysis

BIBLIOGRAPHY

 pubmed.ncbi.nlm.nih.gov/32224733

 journals.lww.com/annalsofsurgery/Fulltext/2020/…

 Younossi ZM, Stepanova M, Afendy M, et al. Changes in the prevalence of the most common
causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol
Hepatol 2011; 9:524–530.e1.

 Wong RJ, Aguilar M, Cheung R, et al. Nonalcoholic steatohepatitis is the second leading
etiology of liver disease among adults awaiting liver transplantation in the United States.
Gastroenterology 2015; 148:547–555.