After bariatric surgery, patients have a “much higher” risk of unhealthy alcohol use—even if they had no documented unhealthy drinking at baseline, according to researchers from the Durham Veteran Affairs (VA) Medical Center in North Carolina.
Based on their findings, the researchers estimate that for every 21 patients who undergo laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB), on average one from each group will develop unhealthy alcohol use.
The researchers collected electronic health record (EHR) data from 2,608 veterans who underwent LSG or RYGB at any bariatric center in the VA health system between 2008 and 2016, and compared that group with a nonsurgical control group.
Nearly all the patients screened negative for unhealthy alcohol use in the 2-year baseline period; however, their mean AUDIT-C scores and the probability of unhealthy alcohol use both increased significantly 3 to 8 years after surgery when compared with the control group. Eight years after an LSG, the probability was 3.4% higher (7.9% vs 4.5%). Eight years after an RYGB, the probability was 9.2% vs 4.4%, a difference of 4.8%.
The estimated prevalence of unhealthy alcohol use 8 years after bariatric surgery was higher for patients with unhealthy drinking at baseline (30 40%) than it was for those without baseline unhealthy drinking (5 - 10%). However, the probability was significantly higher for patients who had an RYGB than it was for nonsurgical control patients after 8 years, which might reflect alcohol pharmacokinetics changes, the researchers say.
Not drinking alcohol is the safest option after bariatric surgery, the researchers say, given that blood alcohol concentration peaks at higher levels after the operation. They advise monitoring patients long-term, using the three-item AUDIT-C scale. And, importantly, they advise cautioning patients undergoing bariatric surgery that drinking alcohol can escalate, even if they have had no history of drinking above recommended limits.