C. Holliday1, M. Sessine1, N. Ibrahim1, M. Alameddine1, J. Brennan1, A. A. Ghaferi1 1University Of Michigan,Ann Arbor, MI, USA
Introduction:
Bariatric surgery is the most effective treatment for morbid obesity; however, there may be significant unanticipated psychosocial effects after surgery. Prior work identified a three-fold increase in the incidence of alcohol use disorder (AUD) after surgery in patients who underwent Roux-en-Y gastric bypass (RYGB). The landscape of bariatric surgery has changed, with sleeve gastrectomy (SG) now comprising over 50% of primary bariatric operations. However, the degree to which patients who undergo SG develop AUD remains unknown. Therefore, we sought to characterize the incidence of AUD in patients who have undergone SG compared to RYGB and potential predisposing patient factors.
Methods:
This study used prospectively collected, patient-reported data from a state-wide quality collaborative. Presence of AUD was determined using the validated Alcohol Use Disorders Identification Test for Consumption (AUDIT-C), with a score ≥4 in men and ≥3 in women suggestive of AUD. We used bivariate chi-square tests for categorical variables and independent samples t-tests for continuous variables. We used multivariable logistic regression to identify patient characteristics that may predispose patients to development of AUD at 1 and 2 years after surgery.
Results:
The prevalence of AUD in all patients who underwent bariatric surgery in our population was 9.6% preoperatively (n=5724), 8.5% at 1 year postoperatively (n=5724), and 14.0% at 2 years postoperatively (n=1381). The preoperative, 1 year, and 2 year prevalence of AUD for SG were 10.1%, 9.0%, and 14.4%, respectively. The preoperative, one year, and two year postoperative prevalence of AUD for RYGB were 7.6%, 6.3%, and 11.9%, respectively. The rate of new onset AUD in the first year following SG and RYGB were 0.75% and 0.54%, respectively. However, in year two, there was a significant increase in the incidence of new onset AUD—8.5% for SG and 7.2% for RYGB (Figure). Predisposing patient factors to AUD development included higher educational level (p<0.01) and higher household income (p<0.01).
Conclusions:
This is the first large, multi-institutional study of AUD in sleeve gastrectomy patients. The prevalence of alcohol use disorder in patients undergoing SG and RYGB was similar pre- and post-operatively. While there was only a slight increase in the incidence of new onset AUD in the first postoperative year, there was a marked increase in new onset AUD in the second year after both SG and RYGB. Understanding the timing and incidence of alcohol use disorder in patients undergoing sleeve gastrectomy—the most commonly performed bariatric operation in the United States—is critical to providing appropriate counseling and treatment.
