Diagnoses related to abuse of alcohol and addictive substances after gastric bypass and sleeve gastrectomy: a nation-wide registry study from Norway

Abstract Background After Roux-n-Y gastric bypass (RYGB) patients are at higher risk of alcohol problems. In recent years, sleeve gastrectomy (SG) has become a common procedure, but the incidence rates of alcohol abuse following SG are unexplored. Objectives To compare incidence rates of diagnoses indicating problems with alcohol or other substances between patients having undergone SG or RYGB with a minimum of 6 months follow-up. Setting All government funded hospitals in Norway providing bariatric surgery. Methods A retrospective population-based cohort study based on data from the Norwegian Patient Registry. The outcomes were ICD-10 diagnoses relating to alcohol (F10) and other substances (F11-F19). Results The registry provided data on 10,208 patients who underwent either RYGB or SG during the years 2008-2014 with a total post-operative observation time of 33,352 person-years. This corresponds to 8,196 patients with RYGB (27,846 person-years, average 3.4 years) and 2,012 patients with SG (5,506 person-years; average 2.7 years). The incidence rate (IR) for the diagnoses related to alcohol problems after RYGB was 6.36 (95% CI: 5.45-7.36) per 1,000 person-years and 4.54 (2.94-6.70) after SG. When controlling for age and sex, adjusted hazard ratio (HR) was 0.75 (0.49-1.14) for SG compared to RYGB. When combining both bariatric procedures, women under 26 years were more likely to have alcohol-related diagnoses (3.2%, 2.1-4.4) than women of 26-40 years (1.6%, 1.1-2.1) or women older than 40 (1.3%, 0.9-1.7). The IR after RYGB for the diagnoses related to problems with substances other than alcohol was 3.48 (95% CI: 2.82-4.25) compared to 3.27 (1.94-5.17) per 1,000 person-years after SG. Controlling for age and sex, the HR was 0.99 (0.60-1.64) for SG compared to RYGB. Conclusions In our study, procedure-specific differences were not found in the risks (RYGB vs. SG) for post-operative diagnoses related to problems with alcohol and other substances within the available observation time. A longer observation period seems required to explore these findings further.