The proportion of bariatric surgery patients with alcohol use disorders (AUDs) is concerning, given that alcohol consumption should be restricted after surgery, suggesting the necessity for close monitoring and post-surgical care, according to a study led by researchers from the Leibniz Institute for Prevention Research and Epidemiology (BIPS), Bremen, Germany. The findings were reported in the paper, ‘Alcohol use disorders after bariatric surgery: a study using linked health claims and survey data’, published in the International Journal of Obesity.
The study assessed the presence of AUDs in bariatric patients before and up to 12 years after surgery, based upon a linked data set comprising health claims data and survey data. The authors used data from one statutory health insurance (SHI) provider included in the German Pharmacoepidemiological Research Database to identify patients with bariatric surgery anytime between 2004 and 2018 and who were still alive at the end of 2018 (n=6,913). After excluding patients (n=1691) who could not be contacted for various reasons (e.g. end of insurance with this SHI or objection to receiving mail), a questionnaire was sent to patients (n=5,222) in 2021 with 2,521 responders. Only patients with at least three years of baseline prior to surgery were considered (n=267) patients without sufficient baseline were excluded. For 103 patients, surveys could not be linked to the claims data due to lack of consent. Therefore, the analysis data set comprised n = 2151 patients. All AUDs were measured with the Alcohol Use Disorders Identification Test (AUDIT) consisting of ten items addressing aspects of alcohol consumption.
The 2,151 patients had a mean age of 54.6 years (95% CI: 54.1—55.0) when they filled the survey, and 80.7% were women. The median time since surgery was six and the mean BMI at the conduction of the survey was 34.8 and 51.9 prior to surgery. The median TWL was 32.7%. For the vast majority of patients has either a Roux-en-Y gastric bypass (RYGB, 50%) or sleeve gastrectomy (43%); 5.5% had a gastric band, 0.3% reported gastric balloons and 1.1% reported other procedures.
In total, 3% of all patients were classified as having an AUD and a diagnosis were 2.2-times more common in men; this difference by sex increased if patients with at least one inpatient diagnosis codes were considered. For both sexes, more than 40% of diagnoses were coded after but not before the surgery. This proportion was 70% if considering only patients with at least one inpatient AUD diagnosis.
For 655 patients, an AUDIT total score could not be computed due to missing of at least one item (predominantly regarding the amount of regular drinking, n=626). Therefore, a total score was available for 1,496 patients. The mean AUDIT score was 3.4 with higher scores in men than in women. Regarding type of surgery the mean AUDIT scores were 3.5 for RYGB, 3.2 for sleeve, 3.0 for a gastric band and 1.2 gastric balloon.
Overall, 9.4% of all patients showed at least hazardous/harmful consumption. The proportion was higher in men than women (17.3% vs. 7.3%). In the sensitivity analyses, these proportions increased to up to 18.3%, also with higher proportions for men (up to 33.7%) than for women (up to 14.4%). The AUDIT categories did not differ regarding age, time since and type of surgery or BMI. A lower TWL was associated with higher proportions of at least hazardous/harmful consumption.
“We found higher rates of AUDs in patients whose surgery had occurred a longer time ago compared with patients with a shorter post-surgical history,” the authors explained. “While this finding has to be treated with caution since longer observation periods per se allow a higher cumulative incidence, this result is consistent with several studies suggesting a slow rather than a rapid development of AUDs over several years after surgery, putting emphasis on the need for long-term follow-up and care."
In addition, the authors also reported that the prevalence as well as the cumulative incidence of AUDs varied by type of bariatric intervention and AUDs were more than twice as high for patients with RYGB, compared with gastric banding patients. However, no data were available for sleeve gastrectomy patients, as at the time of study this procedure was less common than it is today.
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