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Multicenter Study
. 2020 Dec 1;3(12):e2028117.
doi: 10.1001/jamanetworkopen.2020.28117.

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

Matthew L Maciejewski  1   2   3 , Valerie A Smith  1   2   3 , Theodore S Z Berkowitz  1 , David E Arterburn  4   5 , James E Mitchell  6 , Maren K Olsen  1   7 , Chuan-Fen Liu  8 , Edward H Livingston  9   10 , Luke M Funk  11   12 , Adenike Adeyemo  1 , Katharine A Bradley  4   5   8   13
Affiliations
Multicenter Study

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

Matthew L Maciejewski et al. JAMA Netw Open. .

Abstract

Importance: Bariatric surgical procedures have been associated with increased risk of unhealthy alcohol use, but no previous research has evaluated the long-term alcohol-related risks after laparoscopic sleeve gastrectomy (LSG), currently the most used bariatric procedure. No US-based study has compared long-term alcohol-related outcomes between patients who have undergone Roux-en-Y gastric bypass (RYGB) and those who have not.

Objective: To evaluate the changes over time in alcohol use and unhealthy alcohol use from 2 years before to 8 years after a bariatric surgical procedure among individuals with or without preoperative unhealthy alcohol use.

Design, setting, and participants: This retrospective cohort study analyzed 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 1, 2008, and September 30, 2016. Surgical patients without unhealthy alcohol use at baseline were matched using sequential stratification 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. Data were analyzed in February 2020.

Interventions: LSG (n = 1684) and RYGB (n = 924).

Main outcomes and measures: 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), which had been documented in the VA EHR. Alcohol outcomes were estimated with mixed-effects models.

Results: A total of 2608 surgical patients were included in the final cohort (1964 male [75.3%] and 644 female [24.7%] veterans. Mean (SD) age of surgical patients was 53.0 (9.9) years and 53.6 (9.9) years for the matched nonsurgical patients. Among patients without baseline unhealthy alcohol use, 1539 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. In patients without baseline unhealthy alcohol use, the mean AUDIT-C scores and the probability of unhealthy alcohol use both increased significantly 3 to 8 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% [95% CI, 6.4-9.5] vs 4.5% [95% CI, 4.1-4.9]; difference, 3.4% [95% CI, 1.8-5.0])). Similarly, 8 years after an RYGB, the probability of unhealthy alcohol use was higher in surgical vs control patients (9.2% [95% CI, 8.0-10.3] vs 4.4% [95% CI, 4.1-4.6]; difference, 4.8% [95% CI, 3.6-5.9]). The probability of no alcohol use also decreased significantly 5 to 8 years after both procedures for surgical vs control patients. Among patients with unhealthy alcohol use at baseline, prevalence of unhealthy alcohol use was higher for patients who underwent an RYGB than matched controls.

Conclusions and relevance: In this multi-site cohort study of predominantly male patients, among those who did not have unhealthy alcohol use in the 2 years before bariatric surgery, the probability of developing unhealthy alcohol use increased significantly 3-8 years after bariatric procedures compared with matched controls during follow-up.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Maciejewski reported receiving grants from the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH) during the conduct of the study and owning Amgen stock owing to spouse's employment. Dr Smith reported receiving grants from NIDA during the conduct of the study. Mr Berkowitz reported receiving grants from NIH during the conduct of the study. Dr Arterburn reported receiving grants from NIH during the conduct of the study; grants from NIH and Patient-Centered Outcomes Research Institute outside the submitted work; and personal fees from International Federation for the Surgery of Obesity and Metabolic Disorders—Latin American Chapter and World Congress on Interventional Therapy for Diabetes outside the submitted work. Dr Olsen reported receiving grants from NIH during the conduct of the study. Dr Livingston reported being Deputy Editor of JAMA during the conduct of the study. Dr Funk reported receiving grants from NIH during the conduct of the study and grants from the US Department of Veterans Affairs (VA), American College of Surgeons, and NIH outside the submitted work. Dr Bradley reported receiving grants from NIH during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Patterns in Model-Estimated Mean Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) Scores in Laparoscopic Sleeve Gastrectomy (LSG) and Roux-en-Y Gastric Bypass (RYGB) Cohorts Without Unhealthy Alcohol Use at Baseline
Figure 2.
Figure 2.. Differences in Model-Estimated Proportions With Postoperative Unhealthy Alcohol Use Incidence in Laparoscopic Sleeve Gastrectomy (LSG) and Roux-en-Y Gastric Bypass (RYGB) Cohorts Without Unhealthy Alcohol Use at Baseline
Figure 3.
Figure 3.. Patterns in Model-Estimated Mean Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) Scores in Laparoscopic Sleeve Gastrectomy (LSG) and Roux-en-Y Gastric Bypass (RYGB) Cohorts With Unhealthy Alcohol Use at Baseline
Figure 4.
Figure 4.. Differences in Model-Estimated Proportions With Postoperative Unhealthy Alcohol Use Prevalence in Laparoscopic Sleeve Gastrectomy (LSG) and Roux-en-Y Gastric Bypass (RYGB) Cohorts With Unhealthy Alcohol Use at Baseline
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