Alcohol and drugs after surgery

Overview

King WC et al.. Surg Obes Relat Dis 2017 · PMID 28528115 · DOI 10.1016/j.soard.2017.03.021

One in five bypass patients reported new alcohol problem symptoms within 5 years.

Does the study support the specific claim? Yes · Methodological quality: moderate

Original publication

Plain-language summary

Scientific in-depth review

1. Full reference

Authors

King WC, Chen JY, Courcoulas AP, Dakin GF, Engel SG, Flum DR, Hinojosa MW, Kalarchian MA, Mattar SG, Mitchell JE, Pomp A, Pories WJ, Steffen KJ, White GE, Wolfe BM, Yanovski SZ

Journal

Surg Obes Relat Dis

Year

2017

Identifier

PMID 28528115 DOI 10.1016/j.soard.2017.03.021 · PMC5568472

Verification

verified – PubMed E-utilities efetch, 2026-10-25

Retracted

no

Corrections

none

Extent checked

full text

Conflicts of interest and funding

NIDDK cooperative agreement (U01 grants). Several authors report research grants/consulting/proctoring from Covidien, Ethicon, Nutrisystem, PCORI, Apollo Endosurgery, Pacira, J&J/Janssen, Enteromedics, Gore, Medtronic (authors anonymised as Dr. A-H in the accepted manuscript).

2. Research question

Substance use disorder outcomes after RYGB and LAGB

3. Study design and population

Study design

Cohort study – Prospective multicentre observational cohort (LABS-2, 10 US hospitals; NCT00465829), annual assessments up to 7 years; comparison RYGB vs LAGB; no non-surgical control

Population

Adults with severe obesity undergoing first RYGB or LAGB (79.2% women, median age 47, median BMI 45.6, 87.0% white)

Country

USA

Period

Recruitment February 2006 - February 2009; follow-up to January 31, 2015

Sample size

2348 underwent RYGB or LAGB; 2003 analysed (1481 RYGB, 522 LAGB) with baseline and >=1 follow-up assessment

Inclusion and exclusion criteria

Adults >=18 years, first bariatric procedure (RYGB or LAGB) at LABS-2 sites; sleeve gastrectomy (<5% of LABS-2) and other procedures excluded; incidence analyses restricted to those without the respective outcome at baseline

4. Methods and endpoints

Exposure / intervention

RYGB

Comparator

LAGB (and pre-surgery status for prevalence trends)

Endpoints

Past-year AUD symptoms (AUDIT >=8, dependence symptoms or alcohol-related harm), self-reported illicit drug use (marijuana, amphetamines, cocaine, hallucinogens, inhalants, PCP; opioids not assessed), SUD treatment

Statistical methods

Mixed models (unstructured covariance) adjusted for age, smoking and site (predictors of missingness); Poisson mixed models for prevalence trends; product-limit cumulative incidence; multivariable Cox models; sensitivity analyses for MAR and for revisions/reversals

5. Actual results

Results

Prevalence of AUD after RYGB rose from 6.6% (95% CI 5.3-7.9) pre-surgery to 16.4% (14.1-18.7) at year 7 (P<.001); after LAGB AUD remained stable at about 6-8% (trend P=.09). Regular drinking increased after both procedures. Illicit drug use after RYGB 4.4% -> 6.3% (mainly marijuana). 5-year cumulative incidence after RYGB: AUD 20.8% (18.5-23.3), illicit drug use 7.5% (6.1-9.1), SUD treatment 3.5% (2.6-4.8); after LAGB 11.3% (8.5-14.9), 4.9% (3.1-7.6), 0.9% (0.4-2.5). RYGB vs LAGB: AUD AHR 2.08 (1.51-2.85), illicit drugs 1.76 (1.07-2.90), SUD treatment 3.56 (1.26-10.07); sensitivity excluding data after reversal/new procedure: AUD AHR 2.36 (1.68-3.33). Other baseline predictors of incident AUD: male sex AHR 1.74 (1.34-2.24), per 10 y younger 1.44 (1.29-1.60), smoking 1.41 (1.02-1.96), regular drinking 12.68 (8.34-19.26). Weight loss, binge eating and loss-of-control eating were not associated (contrary to 'addiction transfer').

Absolute risks

5-year cumulative incidence of AUD symptoms 20.8% after RYGB vs 11.3% after LAGB; AUD prevalence 6.6% -> 16.4% at 7 years after RYGB; SUD treatment incidence 3.5% vs 0.9%.

Authors' conclusion

RYGB associated with twice the risk of incident AUD symptoms vs LAGB; screening and treatment referral should be part of care.

6. Strengths

• Prospective, large, geographically diverse multicentre cohort
• Validated AUDIT, standardized annual assessments up to 7 years
• Incidence analyses restricted to those without baseline outcome
• Sensitivity analyses for missing data and for revisions/reversals

7. Weaknesses

• No non-surgical control and no randomization; findings cannot necessarily be attributed to surgery (authors)
• Retention 66-78% per year; MAR assumption
• Self-report; potential under-reporting; safety-referral protocol may affect reporting
• AUD screening definition, not DSM-5 diagnosis; lifetime history not assessed, so incident cases mix new-onset and recurrent (authors)
• Sleeve gastrectomy excluded
• Opioids and benzodiazepines not assessed (illicit drug use underestimated)
• Full text is the accepted, unedited manuscript; Table 2 participant counts for RYGB/LAGB appear transposed

8. Risk of bias

Orienting tool

ROBINS-E

Type of assessment

structured assessment based on the full text by a single reviewer (no formal double review)

Full formal assessment

no

Overall risk of bias

some concerns

Rationale

Structured single-reviewer judgement from full text; a formal assessment would require two independent reviewers and a protocol.

Full-text review (25 October 2026): Added 7-year prevalence trajectory (RYGB 6.6%->16.4%; LAGB stable), sample split (1481/522), retention rates, all key AHRs incl. sensitivity analysis (2.36), other predictors, definitions and author COI; bias domains added, overall unchanged (some_concerns).

9. Assessment of the statistical interpretation

The RYGB vs LAGB contrast (AHR about 2 for AUD, robust in sensitivity analysis) is the main causal signal; absolute 5-year incidence of AUD symptoms after RYGB (20.8%) is high but includes recurrent cases and screening-level symptoms. Without a non-surgical control, the general population trend over the same period is unknown.

10. Relevance to the specific claim

Supports C-BAR-07.

11. Independent contrary findings

12. Transferability to Germany and Europe

Applicable.

13. Overall methodological judgement

Solid signal; procedure-specific.

14. Open questions

Risk after sleeve gastrectomy; DSM-based diagnoses; opioid misuse; comparison with non-operated controls.

15. Linked fact checks

• Bariatric surgery is followed by documented rises in self-harm, suicide-related deaths and alcohol use disorder. – Studies supporting the claim
• Gastric bypass is preferable to sleeve gastrectomy (less reflux) and can fully treat type 2 diabetes; for patients who fail dieting, bypass rather than sleeve should be chosen (2021 statement). – Studies contradicting or limiting the claim

Use by the Tayebat archive

Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.

What the archive says about the study

Listed in the archive bibliography only; the archive gives no specific interpretation.

A. What was actually studied?

SUD after RYGB/LAGB

B. What did the authors find?

AUD incidence 20.8% after RYGB

C. What conclusions do the authors themselves draw?

Screening recommended

D. What does the archive derive from it?

Supports narrative on alcohol.

E. Is this derivation scientifically justified?

Consistent with archive message.

Adequacy of the interpretation (by the archive)

not applicable