New onset alcohol use disorder following bariatric surgery

Abstract

Background

Bariatric surgery is the most effective treatment for morbid obesity; however, there may be significant unanticipated psychosocial effects following surgery. Prior studies have identified a threefold increase in the incidence of alcohol use disorder (AUD) after Roux-en-Y gastric bypass (RYGB). With sleeve gastrectomy (SG) now comprising over 50% of primary bariatric operations, the degree to which patients who undergo SG develop AUD remains unknown. We sought to characterize the patients and incidence of AUD following SG compared to RYGB.

Methods

This study used prospectively collected data from a state-wide quality collaborative. The presence of AUD was determined using the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C), with a score ≥ 4 in men and ≥ 3 in women suggestive of AUD. We used bivariate Chi-square tests for categorical variables and independent samples t tests for continuous variables. We used multivariable logistic regression to identify patient characteristics that may predispose patients to development of AUD at 1 and 2 years after surgery.

Results

The overall prevalence of AUD in our population (n = 5724) was 9.6% preoperatively, 8.5% at 1 year postoperatively, and 14.0% at 2 years postoperatively. The preoperative, 1-year, and 2-year prevalence of AUD for SG were 10.1%, 9.0%, and 14.4%, respectively. The preoperative, 1-year, and 2-year postoperative prevalence of AUD for RYGB were 7.6%, 6.3%, and 11.9%, respectively. Predisposing patient factors to AUD development included higher educational level (p < 0.01) and higher household income (p < 0.01).

Conclusions

This is first large, multi-institutional study of AUD following SG. The prevalence of alcohol use disorder in patients undergoing SG and RYGB was similar pre- and postoperatively. The majority of patients developed AUD following their second postoperative year. Understanding the timing and incidence of alcohol use disorder in patients undergoing SG—the most commonly performed bariatric operation in the United States—is critical to providing appropriate counseling and treatment.

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Acknowledgements

The authors would like to thank Aaron J. Bonham, MS (Senior Statistician, University of Michigan) for his statistical support and review of the methodology for this manuscript.

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Correspondence to Amir A. Ghaferi.

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Disclosures

Dr. Amir A. Ghaferi is supported through grants from the Agency for Healthcare Research and Quality (Grant #: 5K08HS02362 and P30HS024403) and a Patient Centered Outcomes Research Institute Award (CE-1304-6596). Dr. Ghaferi receives salary support from Blue Cross Blue Shield of Michigan as the Director of the Michigan Bariatric Surgery Collaborative. Nadine Ibrahim, Mitchell Alameddine, Julia Brennan, Michael Sessine, and Charles Holliday have no conflicts of interest or financial ties to disclose.

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Ibrahim, N., Alameddine, M., Brennan, J. et al. New onset alcohol use disorder following bariatric surgery. Surg Endosc 33, 2521–2530 (2019). https://doi.org/10.1007/s00464-018-6545-x

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Keywords

  • Bariatric surgery
  • Alcohol use disorder
  • Substance use