Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
Department of Statistics, University of Michigan, Ann Arbor, MI, USA.
Liver Int. 2021 May;41(5):1012-1019. doi: 10.1111/liv.14805. Epub 2021 Feb 20.
BACKGROUND & AIMS: Bariatric surgery is common, but alcohol misuse has been reported following these procedures. We aimed to determine if bariatric surgery is associated with increased risk of alcohol-related cirrhosis (AC) and alcohol misuse.
Retrospective observational analysis of obese adults with employer-sponsored insurance administrative claims from 2008 to 2016. Subjects with diagnosis codes for bariatric surgery were included. Primary outcome was risk of AC. Secondary outcome was risk of alcohol misuse. Bariatric surgery was divided into before 2008 and after 2008 to account for patients who had a procedure during the study period. Cox proportional hazard regression models using age as the time variable were used with interaction analyses for bariatric surgery and gender.
A total of 194 130 had surgery from 2008 to 2016 while 209 090 patients had bariatric surgery prior to 2008. Age was 44.1 years, 61% women and enrolment was 3.7 years. A total of 4774 (0.07%) had AC. Overall risk of AC was lower for those who received sleeve gastrectomy and laparoscopic banding during the study period (HR 0.4, P <.001; HR 0.43, P =.02) and alcohol misuse increased for Roux-en-Y and sleeve gastrectomy recipients (HR 1.86 and 1.35, P <.001, respectively). In those who had surgery before 2008, women had increased risk of AC and alcohol misuse compared to women without bariatric surgery (HR 2.1 [95% CI: 1.79-2.41] for AC; HR 1.98 [95% CI 1.93-2.04]).
Bariatric surgery is associated with a short-term decreased risk of AC but potential long-term increased risk of AC in women. Post-operative alcohol surveillance is necessary to reduce this risk.
减重手术较为常见，但有报道称此类手术后会出现酒精滥用。本研究旨在确定减重手术是否与酒精相关性肝硬化（AC）和酒精滥用风险增加相关。
利用 2008 年至 2016 年雇主赞助保险行政索赔记录的肥胖成年人进行回顾性观察性分析。纳入接受过减重手术诊断编码的患者。主要结局为 AC 风险。次要结局为酒精滥用风险。根据研究期间患者接受手术的时间，将减重手术分为 2008 年之前和 2008 年之后。使用年龄作为时间变量的 Cox 比例风险回归模型，结合减重手术和性别交互分析。
2008 年至 2016 年共有 194130 例患者接受手术，2008 年之前有 209090 例患者接受过减重手术。患者年龄为 44.1 岁，61%为女性，登记时间为 3.7 年。共有 4774 例（0.07%）发生 AC。在研究期间接受袖状胃切除术和腹腔镜带术的患者 AC 总体风险较低（HR 0.4，P<.001；HR 0.43，P=.02），Roux-en-Y 和袖状胃切除术患者的酒精滥用风险增加（HR 1.86 和 1.35，P<.001）。在 2008 年之前接受手术的患者中，与未接受减重手术的女性相比，女性 AC 和酒精滥用的风险增加（AC：HR 2.1[95%CI：1.79-2.41]；HR 1.98[95%CI 1.93-2.04]）。
减重手术与短期 AC 风险降低相关，但女性长期 AC 风险增加。需要术后进行酒精监测，以降低这种风险。
