Roux-en-Y tied to increased risk for hospitalization related to alcohol-use disorder
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Roux-en-Y gastric bypass was associated with an increased risk for alcohol-use disorder-related hospitalization compared with sleeve gastrectomy and a weight management program, according to research published in JAMA Surgery.
“Restrictive procedures, such as sleeve gastrectomy or gastric banding and mixed restrictive or malabsorptive procedures, such as Roux-en-Y gastric bypass, are effective in promoting weight loss and reversing underlying metabolic comorbidities, but they may induce differential alterations in alcohol metabolism,” Nadim Mahmud, MD, MS, MPH, MSCE, assistant professor of medicine and epidemiology at University of Pennsylvania Perelman School of Medicine, and colleagues wrote.
“Recent data suggest alcohol consumption increases during prolonged follow-up of patients who underwent bariatric surgery,” they continued. “Thus, it remains unclear if the previously observed increased risk of alcohol-related adverse events is attributable to alterations in metabolism or sensitivity, increased alcohol exposure or both.”
In a retrospective cohort study, Mahmud and colleagues evaluated whether a link exists between bariatric surgery and alcohol-use disorder (AUD)-related hospitalization and all-cause mortality compared with a weight management program. They enrolled 7,694 patients from 127 U.S. Veterans Health Administration centers, all of whom had a BMI of at least 30. Included participants had underwent Roux-en-Y gastric bypass (RYGB; n = 1,854; median age, 53 years; 69.8% men), sleeve gastrectomy (n = 4,211; 52 years; 66.9% men), gastric banding (n = 265; 55 years; 75.1% men) or referral to MOVE!, a weight management program (n = 1,364; 59 years; 86.1% men).
Outcomes of interest included time from bariatric surgery or MOVE! referral to AUD-related hospitalization and all-cause mortality.
During a median follow-up of 59.6 months, RYGB was linked to an increased risk for AUD-related hospitalization compared with MOVE! (HR = 1.7; 95% CI, 1.2-2.41) and sleeve gastrectomy (HR = 1.98; 95% CI, 1.55-2.53). Researchers reported no significant difference in AUD-related hospitalization risk between sleeve gastrectomy and MOVE! (HR = 0.76; 95% CI, 0.56-1.03).
Further, in fully adjusted analyses, RYBG (HR = 0.63; 95% CI, 0.49-0.81) and sleeve gastrectomy (HR = 0.49; 95% CI, 0.39-0.61) were associated with a reduced mortality risk compared with the weight management program, but RYGB was associated with an increased risk compared with sleeve gastrectomy (HR = 1.36; 95% CI, 1.09-1.7).
“Patients who underwent RYGB had a significantly increased risk of AUD-related hospitalizations vs. those who underwent sleeve gastrectomy or those referred to the MOVE! program,” Mahmud and colleagues concluded. “Patients who undergo RYGB may be uniquely sensitive to alcohol exposure, and increased alcohol use may nullify potential gains in overall survival.”
They added, “These findings highlight the importance of careful patient selection for RYGB, strict counseling regarding alcohol use and long-term monitoring for AUD-related complications.”
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