Highlights
- •This register-based study comprises data from 10,208 patients with RYGB and SG.
- •Mean post-operative observation time was 3.3 years.
- •During this period, patients with SG and RYGB had similar risks for diagnoses related to alcohol and other substances.
Abstract
Background
After Roux-en-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 (IRs) of alcohol abuse after SG are unexplored.
Objectives
To compare IRs of diagnoses indicating problems with alcohol or other substances between
patients having undergone SG or RYGB with a minimum of 6-month follow-up.
Setting
All government funded hospitals in Norway providing bariatric surgery.
Methods
A retrospective population-based cohort study based on data from the Norwegian Patient
Registry. The outcomes were ICD-10 of Diseases and Related Health Problems diagnoses
relating to alcohol (F10) and other substances (F11–F19).
Results
The registry provided data on 10,208 patients who underwent either RYGB or SG during
the years 2008 to 2014 with a total postoperative observation time of 33,352 person-years.
This corresponds to 8196 patients with RYGB (27,846 person-yr, average 3.4 yr) and
2012 patients with SG (5506 person-yr; average 2.7 yr). The IR for the diagnoses related
to alcohol problems after RYGB was 6.36 (95% confidence interval: 5.45–7.36) per 1000
person-years and 4.54 (2.94–6.70) after SG. When controlling for age and sex, adjusted
hazard ratio was .75 (.49–1.14) for SG compared with RYGB. When combining both bariatric
procedures, women <26 years were more likely to have alcohol-related diagnoses (3.2%,
2.1–4.4) than women of 26 to 40 years (1.6%, 1.1–2.1) or women >40 (1.3%, .9–1.7).
The IR after RYGB for the diagnoses related to problems with substances other than
alcohol was 3.48 (95% confidence interval: 2.82–4.25) compared with 3.27 (1.94–5.17)
per 1000 person-years after SG. Controlling for age and sex, the hazard ratio was
.99 (.60–1.64) for SG compared with RYGB.
Conclusions
In our study, procedure-specific differences were not found in the risks (RYGB versus
SG) for postoperative 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.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Surgery for Obesity and Related DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Surgery for weight loss in adults.Cochrane Database Syst Rev. 2014; 8: CD003641
- Is bariatric surgery effective in reducing comorbidities and drug costs? A systematic review and meta-analysis.Obes Surg. 2015; 25: 1741-1749
- IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures.Obes Surg. 2018; 28: 3783-3794
- Bariatric surgery history among substance abuse treatment patients: prevalence and associated features.Surg Obes Relat Dis. 2010; 6: 615-621
- Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.Surg Obes Relat Dis. 2017; 13: 1392-1402
- Alcohol consumption and alcohol problems after bariatric surgery in the Swedish Obese Subjects (SOS) study.Obesity (Silver Spring). 2013; 21: 2444-2451
- Increased admission for alcohol dependence after gastric bypass surgery compared with restrictive surgery.JAMA Surg. 2013; 148: 374-377
- Roux-en-Y gastric bypass increases intravenous ethanol self-administration in dietary obese rats.PloS One. 2013; 8e83741
- Does gastric bypass alter alcohol metabolism?.Surg Obes Relat Dis. 2007; 3 (discussion 548): 543-548
- Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery.Br J Clin Pharmacol. 2002; 54: 587-591
- Impaired alcohol metabolism after gastric bypass surgery - a case-crossover trial.J Am Coll Surg. 2011; 212: 209-214
- Blood alcohol concentrations rise rapidly and dramatically after Roux-en-Y gastric bypass.Surg Obes Relat Dis. 2013; 9: 470-473
- High blood alcohol levels in women. The role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism.N Engl J Med. 1990; 322: 95-99
- Sleeve gastrectomy surgery: when 2 two alcoholic drinks are converted to 4.Surg Obes Relat Dis. 2018; 14: 277-283
- Alcohol absorption modification after a laparoscopic sleeve gastrectomy due to obesity.Obes Surg. 2010; 20: 744-748
- Normal alcohol metabolism after gastric banding and sleeve gastrectomy: a case-cross-over trial.J Am Coll Surg. 2012; 215: 475-479
- Alcohol metabolism is not affected by sleeve gastrectomy.Surg Endosc. 2015; 29: 1088-1093
- American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient.Surg Obes Relat Dis. 2008; 4: S109-S184
- ASMBS Position statement on alcohol use before and after bariatric surgery.Surg Obes Relat Dis. 2016; 12: 225-230
- Alcohol treatment utilization: findings from the National Epidemiologic Survey on Alcohol and Related Conditions.Drug Alcohol Depend. 2007; 86: 214-221
- Alcohol consumption, dependence, and treatment barriers: perceptions among nontreatment seekers with alcohol dependence.Subst Use Misuse. 2014; 49: 762-769
- Substance use following bariatric weight loss surgery.JAMA Surg. 2013; 148: 145-150
- Alcohol and substance abuse, depression and suicide attempts after Roux-en-Y gastric bypass surgery.Br J Surg. 2016; 103: 1136-1142
- All bariatric surgeries are not created equal: insights from mechanistic comparisons.Endocr Rev. 2012; 33: 595-622
- Prevalence of alcohol use disorders before and after bariatric surgery.JAMA. 2012; 307: 2516-2525
- Epidemiology of substance use in adolescence: prevalence, trends and policy implications.Drug Alcohol Depend. 1999; 55: 187-207
Article info
Publication history
Published online: December 19, 2019
Accepted:
December 6,
2019
Received:
May 29,
2019
Footnotes
St. Olavs Hospital, Trondheim University Hospital, Norway, funded the study.
Identification
Copyright
© 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
