Diagnoses related to abuse of alcohol and addictive substances after gastric bypass and sleeve gastrectomy: a nation-wide registry study from Norway

Abstract

BackgroundAfter Roux-n-Y gastric bypass (RYGB) patients are at higher risk of alcohol problems. In recent years, sleeve gastrectomy (SG) has become a common procedure, but the incidence rates of alcohol abuse following SG are unexplored. ObjectivesTo compare incidence rates of diagnoses indicating problems with alcohol or other substances between patients having undergone SG or RYGB with a minimum of 6 months follow-up. SettingAll government funded hospitals in Norway providing bariatric surgery. Methods A retrospective population-based cohort study based on data from the Norwegian PatientRegistry. The outcomes were ICD-10 diagnoses relating to alcohol (F10) and other substances (F11-F19). ResultsThe registry provided data on 10,208 patients who underwent either RYGB or SG during the years 2008-2014 with a total post-operative observation time of 33,352 person-years. This corresponds to 8,196 patients with RYGB (27,846 person-years, average 3.4 years) and 2,012 patients with SG (5,506 person-years; average 2.7 years). The incidence rate (IR) for the diagnoses related to alcohol problems after RYGB was 6.36 (95% CI: 5.45-7.36) per 1,000 person-years and 4.54 (2.94-6.70) after SG. When controlling for age and sex, adjusted hazard ratio (HR) was 0.75 (0.49-1.14) for SG compared to RYGB. When combining both bariatric procedures, women under 26 years were more likely to have alcohol-related diagnoses (3.2%, 2.1-4.4) than women of 26-40 years (1.6%, 1.1-2.1) or women older than 40 (1.3%, 0.9-1.7). The IR after RYGB for the diagnoses related to problems with substances other than alcohol was 3.48 (95% CI: 2.82-4.25) compared to 3.27 (1.94-5.17) per 1,000 person-years after SG. Controlling for age and sex, the HR was 0.99 (0.60-1.64) for SG compared to RYGB. ConclusionsIn our study, procedure-specific differences were not found in the risks (RYGB vs. SG) for post-operative diagnoses related to problems with alcohol and other substances within the available observation time. A longer observation period seems required to explore these findings further.

Association of Bariatric Surgical Procedures With Changes in Unhealthy Alcohol Use Among US Veterans

“…In the large sample without unhealthy alcohol use at baseline, the differences in mean alcohol use and the prevalence of unhealthy alcohol use between surgical and control patients tended to be smaller in the LSG cohort than in the RYGB cohort. This is consistent with the finding of a more rapid increase and higher peak blood alcohol concentration with drinking after an RYGB vs an LSG and with a study of alcohol-related diagnoses . Results regarding RYGB are consistent with previous uncontrolled cohort studies that showed that the prevalence of self-reported alcohol use and associated symptoms increased from the time of the bariatric surgical procedure to 2 years and 5 years after the operation.…”

“…This is consistent with the finding of a more rapid increase and higher peak blood alcohol concentration with drinking after an RYGB vs an LSG 11,12 and with a study of alcohol-related diagnoses. 38 Results regarding RYGB are consistent with previous uncontrolled cohort studies that showed that the prevalence of self-reported alcohol use and associated symptoms increased from the time of the bariatric surgical procedure to 2 years 16 and 5 years 7 after the operation.…”

“…Use of the data allowed the evaluation of changes in documented alcohol use from 2 years before to 8 years after the surgical procedure, building on past US prospective cohort studies. 7,[13][14][15][16][17]38,39 Second, this study is the first, to our knowledge, to evaluate alcohol-related outcomes of bariatric surgical procedures in a predominantly male population.…”

Characteristics of Patients Reporting Presumed Problematic Drinking Behavior After Gastric Bypass: Exploring Long-Term Data From the BAROBS Study

“…Since this material entirely consisted of patients undergoing RYGB, another question is the relevance of these findings to sleeve gastrectomy. In an earlier study on registry data we did not find any difference in risks for postoperative diagnoses related to alcohol problems (29). This, together with the physiological similarities between RYGB and sleeve gastrectomy (30), suggests that our findings may have relevance also for patients undergoing sleeve gastrectomy.…”

Problematic alcohol use in post-bariatric patients – a qualitative study

“…Samtidig er disse studiene vanskelige å sammenfa e grunnet ulik oppfølgingstid, operasjonsmetode og utvalg (4). En norsk registerstudie av forekomst av alkoholbrukslidelse e er operasjon fant at 6,36 % e er gastrisk bypass og 4,54 % e er langsgående ventrikkelreseksjon utviklet alkoholbrukslidelse per 1 000 personår (7). Risikoen for utvikling av alkoholavhengighet e er fedmekirurgi er høyere ved gastrisk bypass, og høyere for menn, røykere, de med jevnlig alkoholbruk før operasjonen og yngre personer samt ved bruk av illegale rusmidler og lav grad av tilhørighet (4, 8).…”