S2724 Non-Alcoholic Fatty Liver Disease Is Associated With Increased Inpatient Mortality and Morbidity Following Coronary Artery Bypass Grafting

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a prevalent metabolic condition linked to systemic inflammation and increased cardiovascular risk. Coronary artery bypass grafting (CABG) is a high-risk cardiac procedure, but data on the impact of NAFLD on CABG outcomes remain limited. We evaluated hospitalized patients who underwent CABG, comparing clinical outcomes between those with and without NAFLD, including in-hospital mortality and secondary complications. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (2016–2020) to identify all adult hospitalizations involving CABG, with and without NAFLD, based on International Classification of Diseases, Tenth Revision (ICD-10) codes. Patients with alcohol-related liver disease, viral hepatitis, autoimmune hepatitis, or cirrhosis were excluded. Outcomes included in-hospital mortality, length of stay (LOS), total hospital charges, and complications such as acute kidney injury (AKI), respiratory complications, mechanical ventilation, sepsis, and shock. Survey-weighted multivariable logistic and linear regressions adjusted for demographics, comorbidities, and hospital factors. Results: Among 970,910 weighted CABG hospitalizations, 1.7% (15,810) had NAFLD. Patients with NAFLD included more women (29.0% vs 24.6%), non-White (22.2% vs 21.2%), and greater comorbidity burden (21.5% of NAFLD patients having a Charlson index ≥6 compared to 9.2% of non-NAFLD patients). NAFLD was associated with significantly higher in-hospital mortality (adjusted odds ratio [aOR] 1.97, 95% CI 1.67–2.32, P < 0.001) and greater total hospital charges (adjusted β = + $10,040, 95% CI $1,293–$18,784, P = 0.024). LOS was similar between groups (adjusted β = 0.006 days, P = 0.969). Patients with NAFLD also had higher odds of respiratory complications, mechanical ventilation, and sepsis. No significant differences were observed in AKI or shock requiring vasopressor use. Conclusion: NAFLD is independently associated with increased in-hospital mortality, greater total hospital charges, and higher rates of complications in patients undergoing CABG. These findings highlight the potential role of NAFLD as an underrecognized perioperative risk factor in cardiac surgery. Further studies are warranted to better characterize this association and to develop targeted preoperative risk stratification and management strategies aimed at improving clinical outcomes in this growing patient population.