Researchers looking at the changes over time in alcohol use and unhealthy alcohol use two years after bariatric surgery have reported that for every 21 patients who undergo Roux-en-Y gastric bypass (RYGB) and every 29 patients who undergo laparoscopic sleeve gastrectomy (LSG), on average, one from each group will develop unhealthy alcohol use.
The retrospective cohort study, ‘Association of Bariatric Surgical Procedures With Changes in Unhealthy Alcohol Use Among US Veterans’, published in JAMA Network, is believed to be the first US study to compare long-term alcohol-related outcomes between patients who have RYGB or LSG and those who have not.
The researchers analysed the electronic health record (EHR) data on military veterans who underwent a bariatric surgical procedure at any of the bariatric centers in the US Department of Veterans Affairs (VA) health system between October 2008 and September 2016. Using sequential stratification, they matched surgical patients without unhealthy alcohol use at baseline to nonsurgical control patients without unhealthy alcohol use at baseline, and surgical patients with unhealthy alcohol use at baseline were matched to nonsurgical patients with unhealthy alcohol use at baseline. Mean alcohol use, unhealthy alcohol use, and no alcohol use were estimated using scores from the validated 3-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C).
A total of 2608 surgical patients (LSG, n=1,684 and RYGB, n=924) were included in the study (1,964 male, 75.3%). Mean (SD) age of surgical patients was 53.0 (9.9) years and 53.6 (9.9) years for the matched nonsurgical patients. In total, 1,539 patients who underwent an LSG were matched to 14 555 nonsurgical control patients and 854 patients who underwent an RYGB were matched to 8038 nonsurgical control patients – all were patients without baseline unhealthy alcohol use.
In these patients, the mean AUDIT-C scores and the probability of unhealthy alcohol use both increased significantly three to eight years after an LSG or an RYGB, compared with control patients. Eight years after an LSG, the probability of unhealthy alcohol use was higher in surgical vs control patients (7.9% vs 4.5%).
In addition, eight years after an RYGB, the probability of unhealthy alcohol use was higher in surgical vs control patients (9.2% vs 4.4%), with the probability of no alcohol use decreasing significantly five to eight years after both procedures for surgical vs control patients. The prevalence of unhealthy alcohol use was higher for patients who underwent an RYGB than matched controls for patients with unhealthy alcohol use at baseline.
The researchers cautioned 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. They added that all bariatric surgery patients should be monitored long-term for unhealthy alcohol use, which can be detected with the 3-item AUDIT-C scale.
“This multisite cohort study involving predominantly male US veterans found that the probability of developing unhealthy alcohol use increased three to eight years after both LSG and RYGB in patients without previous unhealthy alcohol use, compared with control patients,” the authors concluded. “Alcohol-related risks were somewhat more pronounced after RYGB than LSG, potentially reflecting the alcohol pharmacokinetics changes after RYGB.”
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