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Original Article
April 2013

Increased Admission for Alcohol Dependence After Gastric Bypass Surgery Compared With Restrictive Bariatric Surgery

Author Affiliations

Author Affiliations: Upper Gastrointestinal Research Unit, Department of Molecular Medicine and Surgery (Drs Östlund and Lagergren); Department of Clinical Sciences, Danderyd Hospital (Drs Backman, Marsk, Stockeld, and Näslund); and Department of Public Health Sciences (Dr Rasmussen), Karolinska Institutet, Stockholm, Sweden; and Division of Cancer Studies, King's College London, London, England (Dr Lagergren).

JAMA Surg. 2013;148(4):374-377. doi:10.1001/jamasurg.2013.700

Importance We demonstrate that patients who have undergone gastric bypass surgery (GBS) have a higher risk of inpatient care for alcohol dependence than those who have undergone restrictive surgery. This highlights a need for health care providers to be aware of this so that early detection and treatment can be put in place.

Objective To evaluate inpatient care for alcohol abuse before and after GBS compared with restrictive surgery (vertical banded gastroplasty and gastric banding).

Design Retrospective population-based cohort study including all patients who underwent GBS, vertical banded gastroplasty, and gastric banding in Sweden from 1980 through 2006. The relative risk of inpatient care for alcohol abuse was studied before and after surgery.

Setting All hospitals in Sweden performing bariatric surgery.

Participants A total of 11 115 patients older than 18 years (mean [SD] age, 40.0 [10.3] years; 77% women) who underwent a primary gastric bypass procedure, vertical banded gastroplasty, and gastric banding during the study period.

Main Outcome Measures Inpatient care for alcohol abuse, substance abuse, depression, and attempted suicide.

Results Mean follow-up time was 8.6 years. Before surgery, there was no difference in inpatient treatment of alcohol abuse among patients who underwent gastric bypass or a restrictive procedure (incidence rate ratio, 1.1; 95% CI, 0.8-1.4). After surgery, there was a 2-fold increased risk of inpatient care for alcohol abuse among patients who had GBS compared with those who had restrictive surgery (hazard ratio, 2.3; 95% CI, 1.7-3.2).

Conclusions and Relevance Patients who had undergone GBS had more than double the risk of inpatient care for alcohol abuse postoperatively compared with patients undergoing a restrictive procedure, highlighting a need for healthcare professionals to be aware of this for early detection and treatment.