New onset alcohol use disorder following bariatric surgery

Background: Bariatric surgery is the most effective treatment for morbid obesity; however, there may be significant unanticipated psychosocial effects following surgery. Prior studies have identified a threefold increase in the incidence of alcohol use disorder (AUD) after Roux-en-Y gastric bypass (RYGB). With sleeve gastrectomy (SG) now comprising over 50% of primary bariatric operations, the degree to which patients who undergo SG develop AUD remains unknown. We sought to characterize the patients and incidence of AUD following SG compared to RYGB.

Methods: This study used prospectively collected data from a state-wide quality collaborative. The presence of AUD was determined using the 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 overall prevalence of AUD in our population (n = 5724) was 9.6% preoperatively, 8.5% at 1 year postoperatively, and 14.0% at 2 years postoperatively. The preoperative, 1-year, and 2-year prevalence of AUD for SG were 10.1%, 9.0%, and 14.4%, respectively. The preoperative, 1-year, and 2-year postoperative prevalence of AUD for RYGB were 7.6%, 6.3%, and 11.9%, respectively. Predisposing patient factors to AUD development included higher educational level (p < 0.01) and higher household income (p < 0.01).

Conclusions: This is first large, multi-institutional study of AUD following SG. The prevalence of alcohol use disorder in patients undergoing SG and RYGB was similar pre- and postoperatively. The majority of patients developed AUD following their second postoperative year. Understanding the timing and incidence of alcohol use disorder in patients undergoing SG-the most commonly performed bariatric operation in the United States-is critical to providing appropriate counseling and treatment.