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Self-harm emergency risk increases after bariatric surgery

Although few patients who underwent bariatric surgery had self-harm emergencies, the risk increased significantly following surgery, according to recently published study results.

Researchers conducted a population-based cohort analysis of 8,815 adults (mean age, 42 years; 81.4% women) who underwent bariatric surgery between April 1, 2006, and March 31, 2011, in Ontario, Canada. Patients were followed for 3 years prior to surgery and 3 years after surgery.

Self-harm emergencies during the follow-up periods were the primary outcomes.

Among the patients, 80.1% were aged 35 years or older and 98.5% had undergone gastric bypass. There were 158 self-harm emergencies reported for 111 patients. Eleven patients experienced self-harm emergencies in both follow-up periods.

The number of self-harm emergencies increased after surgery compared with before surgery: 3.63 vs. 2.33 per 1,000 patient-years, for a rate ratio (RR) of 1.54 (95% CI, 1.03-2.3).

Patients older than 35 years old had a higher rate of self-harm emergencies after surgery (RR = 1.76; 95% CI, 1.05-2.94), as did patients with low-income status (RR = 2.09; 95% CI, 1.2-3.65) and patients living in rural areas (RR = 6.49; 95% CI, 1.42-29.63). Intentional overdose was the most common self-harm mechanism (72.8%), while physical trauma, including self-hanging accounted for 20.9% of self-harm mechanisms. In approximately half of events, ambulance involvement occurred. There were no reports of ED deaths related to self-harm.

Most of the events (93%) occurred in patients diagnosed with a mental health disorder within 5 years prior to surgery.

“Because self-harm emergencies are a strong predictor of suicide, these findings highlight the importance of screening for self-harm behaviors in patients undergoing bariatric surgery,” the researchers wrote.

“These adverse events undermine the overall benefits of bariatric surgery,” the researchers concluded. “Additional clinical implications include active postoperative screening for self-harm risk among patients who have undergone surgery and are presenting for follow-up.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.