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Drug- and alcohol-related mortality risk after bariatric surgery: evidence from a 7-year prospective multicenter cohort study

      Highlights

      • -
        10 drug or alcohol-related deaths occurred across 15616 person-years of follow-up.
      • -
        All 10 drug or alcohol-related deaths occurred post-Roux-en-Y gastric bypass.
      • -
        The observed drug and alcohol-related mortality rate was higher than expected.

      Abstract

      Background

      It is unclear whether bariatric surgery affects the risk of drug- and alcohol-related mortality.

      Objectives

      To compare the observed drug- and alcohol-related mortality rate with age, sex, race, and year-adjusted rates from the general U.S. population.

      Setting

      The Longitudinal Assessment of Bariatric Surgery-2, a prospective cohort study of 2458 adults who underwent bariatric surgery at 10 U.S. hospitals between April 2006 and April 2009.

      Methods

      Participants attended presurgery and annual postsurgery assessments for up to 7 years. Drug- and alcohol-related standardized mortality ratios (SMR) comparing the observed post-bariatric surgery mortality rate with the age, sex, race, and year-adjusted expected mortality rate from the general U.S. population, among the entire cohort, and among those who underwent Roux-en-Y gastric bypass (RYGB).

      Results

      Ten deaths related to drug or alcohol use (6 accidental overdose, 1 intentional overdose, 1 intent unknown overdose, and 2 alcoholic liver disease) occurred across 15,616 person-years of follow-up, all among participants who underwent RYGB (n = 1770). The observed mortality rate was significantly higher than expected for all drug- and alcohol-related causes overall (SMR = 2.10, 95% confidence interval = 1.01–3.86, P = .03) and among participants who underwent RYGB (SMR = 2.90, 95% confidence interval = 1.39–5.33, P = .003). The RYGB SMRs were significant for all overdoses (P = .002) and accidental overdoses (P = .01) and in the same direction but nonsignificant for intentional overdoses, intent unknown overdoses, and alcoholic liver disease (P for all ≥. 05).

      Conclusions

      Drug- and alcohol-related mortality is significantly higher than expected in the 7 years after bariatric surgery, specifically after RYGB.

      Key words

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