RYGB associated with more alcohol-related hospitalizations than other weight-loss strategies

A recent cohort study compared hospitalizations related to alcohol use disorder and mortality among veterans who received Roux-en-Y gastric bypass (RYGB) surgery, sleeve gastrectomy, or referral to a weight management program.

Roux-en-Y gastric bypass (RYGB) surgery is associated with higher risk of hospitalization due to alcohol use disorder (AUD) than some other weight-loss strategies, a study found.

This cohort study included patients from 127 Veterans Health Administration health centers in the U.S.: 1,854 who received RYGB, 4,211 who received sleeve gastrectomy, 265 who received gastric banding, and 1,364 who were referred to the weight management program MOVE! All had a body mass index (BMI) of 30 kg/m2 or greater and were treated in 2008 to 2021. The primary outcome was time to AUD-related hospitalization from the time of surgery or MOVE! referral. Results were published by JAMA Surgery on Dec. 14.

In inverse probability treatment-weighting Cox regression analyses accounting for time-updating alcohol use and BMI, RYGB was associated with an increased risk of AUD-related hospitalization compared to MOVE! (hazard ratio [HR], 1.70 [95% CI, 1.20 to 2.41]; P=0.003) and compared to sleeve gastrectomy (HR, 1.98 [95% CI, 1.55 to 2.53]; P<0.001). There was no significant difference between sleeve gastrectomy and MOVE! (HR, 0.76 [95% CI, 0.56 to 1.03]; P=0.08). Patients who got RYGB had reduced mortality during follow-up compared to those in the MOVE! group (HR, 0.63 [95% CI, 0.49 to 0.81]; P<0.001), but that benefit was mitigated by increasing alcohol use over time.

“We found that patients who underwent RYGB had a higher risk of AUD-related hospitalization despite generally consuming the least amount of alcohol at baseline or during follow-up, suggesting that alterations in alcohol metabolism more than changes in alcohol consumption may be associated with increased risks of alcohol-related complications in patients who underwent RYGB,” the authors said. “These findings highlight the importance of careful patient selection for RYGB, strict counseling regarding alcohol use, and long-term monitoring for AUD-related complications.”

An accompanying editorial comment noted that the trend of more AUD-related hospitalizations is concerning, and the author called on surgeons to “engage, educate, and collaborate with our primary care colleagues on long-term bariatric surgery patient care.”