Persons with no such history pre-surgery run increased risk

The risk of engaging in unhealthy alcohol use among persons with no history of alcohol consumption increases after bariatric surgery, researchers found.

According to a study of U.S. veterans who underwent bariatric surgery, among those who had no history of unhealthy alcohol use in the two years before surgery, that risk increased significantly 3-8 years after the surgery.

The study, from Matthew L. Maciejewski, PhD, Durham VA Medical Center, Durham, North Carolina, and colleagues, was published in JAMA Network Open.

While bariatric surgery confers notable advantages, such as sustained weight loss, it has also been associated with some risks, including the potential of unhealthy alcohol use. “Unhealthy alcohol use spans a spectrum from drinking at levels that increase the risk of health consequences to severe alcohol use disorders, which are associated with extensive disability and death,” the study authors explained.

In a commentary accompanying the study, Anne C. Fernandez, PhD, Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, wrote that these findings suggest that a more vigorous effort to improve preoperative alcohol education, counseling, and problem prevention before surgery is needed, regardless of the history of past alcohol use.

The results, along with previous laboratory studies, suggest there may be causal mechanisms — such as alcohol metabolism, pharmacokinetics, and reward processing after bariatric surgical procedures – at play, Fernandez observed. “This body of coalescing evidence supports the conclusion that unhealthy alcohol use is an iatrogenic complication of bariatric surgical procedures, a finding that is of substantial clinical concern and warrants further inquiry,” she wrote.

Maciejewski and colleagues noted that current research evaluating the association between bariatric surgery and alcohol-related risks have been limited to laboratory studies, and the Swedish study addressing the subject did not include laparoscopic sleeve gastrectomy (LSG), which is the most common bariatric procedure in the U.S. Additionally, no U.S. study has compared the impact of bariatric surgery on long-term related outcome between patients who have under Roux-en-Y gastric bypass (RYGB) and those who have not.

Here, in this retrospective cohort study, Maciejewski and colleagues analyzed electronic health record data on U.S. veterans who underwent bariatric surgery in the U.S. Veterans Affairs health system between October 2008 and September 2016. They compared alcohol-related outcomes between patients who underwent LSG or RYGB and those who didn’t (controls).

For purposes of the study, surgical patients without a history of unhealthy alcohol use were matched to similar nonsurgical control patients at baseline, and surgical patients with unhealthy alcohol use at baseline were matched to nonsurgical patients with unhealthy alcohol use.

Alcohol-related outcomes were derived from using the 3-item Alcohol Use Disorders Identification Test Consumption (AUDIT-C), which had been documented in the Veterans Affairs EHR.

There were 2,608 surgical patients included in the study. Among patients without baseline unhealthy alcohol use, 1539 patients who underwent an LSG were matched to 14,555 nonsurgical control patients, and 854 patients who underwent an RYGB were matched to 8,038 nonsurgical control patients. In patients without baseline unhealthy alcohol use, the mean AUDIT-C scores and the probability of unhealthy alcohol significantly increased 3-8 years after a bariatric procedure, compared with control patients. The probability of unhealthy alcohol use 8 years after an LSG was higher in surgical versus control patients (7.9% [95% CI, 6.4-9.5] versus 4.5% [95% CI, 4.1-4.9]; difference, 3.4% [95% CI, 1.8-5.0]), while for RYGB the probability of unhealthy alcohol use after 8 years was higher in surgical versus control patients (9.2% [95% CI, 8.0-10.3] versus 4.4% [95% CI, 4.1-4.6]; difference, 4.8% [95% CI, 3.6-5.9]).

For latest news and updates

The probability of no alcohol use decreased significantly 5-8 years after surgery in surgical patients, compared with control patients. Patients who underwent an LSG had less EHR documentation of no alcohol use compared with nonsurgical control patients after 8 years (57.3% [95% CI, 54.1- 60.5] versus 67.1% [95% CI, 66.0-68.1]; difference, −9.7% [95% CI, −13.1% to −6.4%]), while patients who underwent an RYGB had less EHR documentation of no alcohol use compared with control patients (59.1% [95% CI, 56.8-61.3] versus 67.4% [95% CI, 66.6-68.1]; difference, −8.3% [95% CI, −10.1% to −5.9%]).

Among the 215 surgical patients with unhealthy alcohol use at baseline, the prevalence of unhealthy alcohol use was higher for patients who underwent an RYGB than matched controls. However, there was no significant difference between patients who underwent LSG and controls.

Maciejewski and colleagues estimated that 1 out of every 21 patients who undergo RYGB, and 1 out of every 29 patients who undergo LSG, will develop unhealthy alcohol use.

“The clinical implications of these results suggest that patients undergoing bariatric surgical procedures should be cautioned that drinking alcohol can escalate after bariatric surgery, even in patients with no previous evidence of drinking alcohol above recommended limits,” wrote Maciejewski and colleagues. “Although no expert consensus exists on the recommended limits for those who drink alcohol, not drinking alcohol is the safest option after a bariatric surgical procedure.”

  1. Patients with no history of misusing alcohol have an increased risk of unhealthy alcohol use after undergoing bariatric surgery.

  2. Alcohol-related risks were slightly greater after Roux-en-Y gastric bypass compared to laparoscopic sleeve gastrectomy.

Michael Bassett, Contributing Writer, BreakingMED™

Maciejewski reported receiving grants from the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH) during the conduct of the study and owning Amgen stock owing to spouse’s employment.

Fernandez reported receiving grants from the National Institute of Alcohol Abuse and Alcoholism and contracts from the Michigan Department of Health and Human Services Contracts outside the submitted work.

Cat ID: 192

Topic ID: 86,192,730,188,192,518,144,146,479,917,159