Impact of bariatric surgery on cardiovascular and cerebrovascular outcomes in metabolic dysfunction–associated steatotic liver disease: a nationwide analysis

Background The prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD) continues to rise, with strong associations with obesity and cardiometabolic diseases. Bariatric surgery (BS) has shown metabolic benefits in MASLD, but its impact on major adverse cardiovascular and cerebrovascular events (MACCE) remains unclear.Methods National Inpatient Sample data from 2016 to 2022 were used to identify adults aged ≥18 years with hepatic steatosis or steatohepatitis and at least one metabolic risk factor, approximating established MASLD criteria. Patients were then stratified by prior BS status, and multivariable logistic regression was used to assess the outcomes after adjustment for potential confounders. Outcomes were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).Results Among 3,668,314 MASLD patients, 394,535 underwent BS. BS was associated with lower odds of all-cause mortality (aOR 0.33, 95% CI 0.32–0.34), myocardial infarction (aOR 0.38, 95% CI 0.36–0.39), stroke (aOR 0.87, 95% CI 0.86–0.88), atrial fibrillation (aOR 0.73, 95% CI 0.72–0.74), and heart failure (aOR 0.52, 95% CI 0.52–0.57); all P < 0.001. Length of stay and total hospital charges were also significantly reduced.Conclusion BS was associated with lower risk of MACCE, mortality, and resource utilization in patients with MASLD, supporting its beneficial role.