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Pre-Operative Substance Use Disorder is Associated with Higher Risk of Long-Term Mortality Following Bariatric Surgery

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Abstract

Purpose

Metabolic and bariatric surgery (MBS) has been associated with reduced all-cause mortality. While the number of subjects with substance use disorders (SUD) before MBS has been documented, the impact of pre-operative SUD on long-term mortality following MBS is unknown. This study assessed long-term mortality of patients with and without pre-operative SUD who underwent MBS.

Materials and Methods

Two statewide databases were used for this study: Utah Bariatric Surgery Registry (UBSR) and the Utah Population Database. Subjects who underwent MBS between 1997 and 2018 were linked to death records (1997–2021) to identify any death and cause for death following MBS. All deaths (internal, external, and unknown reasons), internal deaths, and external deaths were the primary outcomes of the study. External causes of death included death from injury, poisoning, and suicide. Internal causes of death included deaths that were associated with natural causes such as heart disease, cancer, and infections. A total of 17,215 patients were included in the analysis. Cox regression was used to estimate hazard ratios (HR) of controlled covariates, including the pre-operative SUD.

Results

The subjects with pre-operative SUD had a 2.47 times higher risk of death as compared to those without SUD (HR = 2.47, p < 0.01). Those with pre-operative SUD had a higher internal cause of death than those without SUD by 129% (HR = 2.29, p < 0.01) and 216% higher external mortality risk than those without pre-operative SUD (HR = 3.16, p < 0.01).

Conclusion

Pre-operative SUD was associated with higher hazards of all-cause, internal cause, and external cause mortality in patients who undergo bariatric surgery.

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Acknowledgements

We thank the Utah Clinical and Translational Science Institute (CTSI) (funded by NIH Clinical and Translational Science Awards), the Pedigree and Population Resource, University of Utah Information Technology Services and Biomedical Informatics Core for establishing the Master Subject Index between the Utah Population Database and the University of Utah Health Sciences Center.

Funding

Partial support for all datasets within the Utah Population Database was provided by the University of Utah Huntsman Cancer Institute and the Huntsman Cancer Institute Cancer Center Support grant (grant number P30 CA2014) from the National Cancer Institute.

Research was supported by the NCRR grant, “Sharing Statewide Health Data for Genetic Research” (R01 RR021746, G. Mineau, PI) with additional support from the Utah Department of Health and Human Services and the University of Utah.

Author information

Authors and Affiliations

  1. Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA

    Jaewhan Kim, Joshua Kelley & Jake Magel

  2. Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN, 55455, USA

    Sayeed Ikramuddin

  3. Intermountain Health Care, 5300 South State Street, Murray, UT, 84107, USA

    Nathan Richards

  4. Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA

    Ted Adams

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  1. Jaewhan Kim
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Corresponding author

Correspondence to Jaewhan Kim.

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Informed Consent

This does not apply.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent was not required.

Conflict of Interest

Ted Adams has received research funding from NIH-NIDDK; Ethicon Endo-Surgery; and Intermountain Medical Research and Education Foundation, Intermountain Healthcare. Jaewhan Kim has received research funding from Utah Department of Health and Intermountain Medical Research and Education Foundation. Jake Magel has received research funding from NIH-NCCIH. Joshua Kelley, Sayeed Ikramuddin, and Nathan Richards have no conflict of interest.

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Key Points

1. SUD before MBS has important prevalence.

2. SUD before MBS is associated with an increased risk of long-term mortality.

3. Subjects with pre-operative SUD had a higher risk of external mortality.

Appendix 1

Appendix 1

Table

Table 5 ICD-9 and 10 Codes used to Classify Internal and External Cause of Death
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5

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Kim, J., Kelley, J., Ikramuddin, S. et al. Pre-Operative Substance Use Disorder is Associated with Higher Risk of Long-Term Mortality Following Bariatric Surgery. OBES SURG 33, 1659–1667 (2023). https://doi.org/10.1007/s11695-023-06564-9

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