Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
Surg Obes Relat Dis. 2017 Aug;13(8):1392-1402. doi: 10.1016/j.soard.2017.03.021. Epub 2017 Mar 31.
Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) after bariatric surgery is limited.
To report SUD-related outcomes after RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes.
10 U.S. hospitals METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a prospective cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to 7 years through January 2015.
Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age: 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95% confidence interval (CI): 18.5-23.3), 7.5% (95% CI: 6.1-9.1), and 3.5% (95% CI: 2.6-4.8), respectively, post-RYGB, and 11.3% (95% CI: 8.5-14.9), 4.9% (95% CI: 3.1-7.6), and .9% (95% CI: .4-2.5) post-LAGB. Undergoing RYGB versus LAGB was associated with higher risk of incident AUD symptoms (adjusted hazard ratio or AHR = 2.08 [95% CI: 1.51-2.85]), illicit drug use (AHR = 1.76 [95% CI: 1.07-2.90]) and SUD treatment (AHR = 3.56 [95% CI: 1.26-10.07]).
Undergoing RYGB versus LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.
经验证据表明 Roux-en-Y 胃旁路术（RYGB）会增加酒精使用障碍（AUD）的风险。然而，对减肥手术后物质使用障碍（SUD）的前瞻性评估是有限的。
报告 RYGB 和腹腔镜可调节胃束带术（LAGB）后的 SUD 相关结果。确定与 SUD 相关结果发生相关的因素。
美国 10 家医院。
纵向评估减肥手术-2 是一项前瞻性队列研究。参与者在术前和术后每年通过自我报告过去一年的 AUD 症状（通过酒精使用障碍识别测试确定）、非法药物使用（可卡因、迷幻剂、吸入剂、苯环己哌啶、苯丙胺或大麻）和 SUD 治疗（酒精或药物的咨询或住院治疗），直至 2015 年 1 月。
在接受 RYGB 或 LAGB 的 2348 名参与者中，有 2003 名完成了基线和随访评估（79.2%的女性，基线中位年龄：47 岁，中位体重指数 45.6）。术后 5 年 AUD 症状、非法药物使用和 SUD 治疗的累积发生率分别为 20.8%（95%置信区间：18.5-23.3）、7.5%（95%置信区间：6.1-9.1）和 3.5%（95%置信区间：2.6-4.8），分别为 RYGB 后，LAGB 后分别为 11.3%（95%置信区间：8.5-14.9）、4.9%（95%置信区间：3.1-7.6）和 0.9%（95%置信区间：0.4-2.5）。与 LAGB 相比，RYGB 与 AUD 症状（调整后的危险比或 AHR = 2.08 [95%置信区间：1.51-2.85]）、非法药物使用（AHR = 1.76 [95%置信区间：1.07-2.90]）和 SUD 治疗（AHR = 3.56 [95%置信区间：1.26-10.07]）的发生率增加有关。
与 LAGB 相比，RYGB 与 AUD 症状的发生率增加了两倍。五分之一的参与者在 RYGB 后 5 年内报告了 AUD 症状。应在术前和术后护理中纳入 AUD 教育、筛查、评估和治疗转诊。
