Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.
Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.
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饮酒和减肥手术后的其他药物：来自美国多中心队列研究的前瞻性证据。
DOI：
10.1016/j.soard.2017.03.021
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发表时间：
2017-08
期刊：
影响因子：
--
通讯作者：
Yanovski SZ
中科院分区：
文献类型：
--
作者：
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
经验证据表明，Roux-en-Y胃旁路术（RYGB）增加了发生酒精使用障碍（AUD）的风险。然而，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相关结局。确定与SUD相关事件结局相关的因素。美国10家医院减肥手术的纵向评估-2是一项观察性队列研究。参与者自我报告了过去一年的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，致幻剂，吸入剂，苯环己哌啶，安非他明或大麻）和SUD治疗（咨询或因酒精或药物住院）术前和术后每年长达7年，直到2015年1月。在2348名接受RYGB或LAGB的参与者中，2003年完成了基线和随访评估（79.2%为女性，基线中位年龄47岁，中位体重指数45.6）。术后发生AUD症状、非法药物使用和SUD治疗的5年累积发生率为20.8%（95%CI，18.5-23.3），7.5% RYGB后分别为11.3%（95%CI，6.1-9.1）和3.5%（95%CI，2.6-4.8），LAGB后分别为11.3%（95%CI，8.5-14.9）、4.9%（95%CI，3.1-7.6）和0.9%（95%CI，0.4-2.5）。与LAGB相比，接受RYGB的患者发生AUD症状（AHR=2.08 [95%CI，1.51-2.85]）、非法药物使用（AHR=1.76 [95%CI，1.07-2.90]）和SUD治疗（AHR=3.56 [95%CI，1.26-10.07]）的风险更高。进行RYGB与LAGB相比，发生AUD症状的风险是LAGB的两倍。五分之一的参与者在RYGB后5年内报告了AUD症状。AUD教育、筛查、评估和治疗转诊应纳入术前和术后护理。
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) following bariatric surgery is limited. To report SUD-related outcomes following RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes. Ten US hospitals. The Longitudinal Assessment of Bariatric Surgery-2 is an observational 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 seven 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%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 0.9% (95%CI, 0.4-2.5) post-LAGB. Undergoing RYGB vs. LAGB was associated with higher risk of incident AUD symptoms (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 vs. 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.
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