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LOWER RISK OF ALCOHOL USE DISORDER AFTER SLEEVE GASTRECTOMY COMPARED TO GASTRIC BYPASS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Abraham Z. Cheloff
*1, Sigrid Young
1,3, Leah Kim
1, Violeta Popov
1,21Internal Medicine, NYU Langone Health, New York, NY; 2VA New York Harbor Healthcare System, New York, NY; 3University of California Los Angeles, Los Angeles, CA
Introduction: For patients unable to sustain long-term weight loss through dietary and lifestyle changes, bariatric surgery offers effective treatment. Options include the Roux-en-Y gastric bypass (RYGB) and procedures restricting the stomach such as the sleeve gastrectomy (SG). There have been reports of increased alcohol use following bariatric surgery. However, other studies have shown a reduction in alcohol use, and the effect of intervention type on alcohol use is unknown. This meta-analysis aimed to assess the rate of new alcohol use disorder (AUD) and high-risk alcohol use after bariatric surgery.
Methods: MEDLINE and Embase were searched through February 2024 for published studies with at least 10 patients that reported post-operative alcohol use after bariatric surgery. Studies were included if they reported AUDIT-C scores, AUD by the DSM-5 criteria or self-reported data. The primary outcome was the % pooled event rate (ER) for new high-risk alcohol use and AUD after bariatric surgery. Secondary outcomes included the calculated odds ratio (OR) of new high-risk alcohol use and AUD after bariatric surgery as compared to pre-surgery within the same cohort (mirror-image analysis). Heterogeneity (I2) was defined as significant if greater than 50%, which was investigated via subgroup analysis and metaregression by surgery type, year of publication, patient age, and study country of origin.
Results: Our search resulted in 1332 original studies, of which 54 studies, 934,824 patients, and 1,443,679 patient-years were included. There were 33 studies evaluating patients post-RYGB, 19 post-restrictive procedures, and 16 reporting mixed surgery data. The pooled event rate for new high-risk alcohol use or AUD after bariatric surgery was 2.49% (95%CI 2.34-2.65%) (Figure 1). Subgroup analysis revealed significant differences by procedure type, with RYGB having a pooled rate of 1.96% (95%CI 1.71-2.20) vs restrictive procedures 1.48% (95%CI 1.32-1.64), p=0.001, with no significant difference between RYGB and SG (1.71%, 95%CI 1.47-1.95, p=0.16). Significant heterogeneity (I2 = 99.93%) was found and sensitivity analysis showed 18% could be explained by the difference in procedure type and year of publication. Mirror-image analysis showed an odds ratio of high-risk alcohol use or AUD after RYGB of 1.81 (95%CI 1.06-3.08, p=0.03), and an odds ratio of 0.67 after SG (95%CI 0.14-3.08, p=0.60) (Figure 2). Both had significant remaining heterogeneity.
Discussion: Alcohol use remains a concern after bariatric surgery. However, there were significant differences between procedure types. While the odds of new high-risk alcohol use or AUD post-surgery is higher after RYGB, it is lower after restrictive procedures. These results have important implications for patient selection and risk stratification pre-procedure as well as management post-surgery.
Figure 1: Event rate for new high-risk alcohol use or AUD after bariatric surgery
Figure 2: Mirror-image analysis calculated odds ratio of high-risk alcohol use or AUD after A) RYGB B) Sleeve Gastrectomy
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