Long-term Mental Health Outcomes of Bariatric Surgery

 描述（由申请人提供）：大量随机试验和观察性研究发现，Roux-en-Y胃旁路术、可调节胃束带术和垂直袖状胃切除术可显著减轻体重，改善对许多慢性疾病的控制。因此，减肥手术的比率在过去二十年中有所增加。减肥手术有短期的好处，但对长期结果，特别是心理健康结果知之甚少。新出现的证据表明，减肥手术可能会诱发新发阿片类药物使用障碍（OUD）或酒精滥用（AM），并加重现有的AM或OUD。肥胖者的AM发生率高于超重和正常体重的人，并且AM在手术后两年内似乎会恶化。肥胖的人也有更高的抑郁率，手术后1-2年似乎会减少。减肥手术可能在短期内对OUD和AM产生不良影响，但减肥手术后5年的这些结局几乎一无所知，因为少数研究检查这些结局仅限于主要非US手术队列的1- 2年随访，并且缺乏非手术患者来解释回归均值。在男性或老年患者中，AM、处方阿片类药物滥用或减肥手术后抑郁症也存在重大证据缺口，因为少数研究这些结果的研究主要由年轻女性患者组成。此外，没有证据表明这些问题是否会减轻手术对3年后体重变化的影响。 我们已经进行了几项关于退伍军人减肥手术后结果的研究。基于我们对2002-2011年接受减肥手术的2,257名退伍军人和>7,000名非手术对照的匹配队列的经验，我们建议在四个具体目标中解决关于AM，OUD和抑郁症治疗术后5年率的关键证据差距：目标1：在减肥手术患者和匹配的非手术患者中检查AM患病率的长期趋势（基于经验证的筛选），这些患者有或没有公认的AM病史。目标二：检查减肥手术患者和基线时有和无阿片类药物滥用的匹配患者中处方阿片类药物滥用的长期变化。目标3：检查减肥手术患者以及基线时接受和未接受抑郁治疗的匹配患者的长期抑郁治疗率。目标4：检查基线AM、处方阿片类药物使用和抑郁症治疗是否会减轻减肥手术对长期体重变化的影响。次要目的：检查接受RYGB，AGB或VSG的患者术后AM，处方阿片类药物使用和抑郁治疗的长期变化是否不同。

 DESCRIPTION (provided by applicant): Numerous randomized trials and observational studies have found that Roux-en-Y gastric bypass, adjustable gastric banding, and vertical sleeve gastrectomy cause dramatic weight loss and improved control of many chronic conditions. As a result, rates of bariatric surgery have increased over the past two decades. Bariatric surgery has short term benefits but less is known about long-term outcomes, particularly mental health outcomes. Emerging evidence suggests that bariatric surgery may induce new onset opioid use disorder (OUD) or alcohol misuse (AM) and exacerbate existing AM or OUD. Obese people have greater rates of AM than overweight and normal weight people and AM appears to worsen two years after surgery. Obese people also have greater rates of depression, which appears to decrease 1-2 years after surgery. Bariatric surgery may have adverse effects on OUD and AM in the short term, but almost nothing is known about these outcomes 5 years after bariatric surgery, because the few studies examining these outcomes were limited to 1- 2 year follow-up of predominantly non-US surgical cohorts and lacked non-surgical patients to account for regression to the mean. There is also a major evidence gap for AM, prescription opioid misuse or depression after bariatric surgery in men or older patients because the few studies examining these outcomes were mostly comprised of younger female patients. Further, there is no evidence whether these issues moderate the effect of surgery on weight change beyond 3 years. We have conducted several studies of veterans' outcomes following bariatric surgery. Building on our experience with matched cohorts of 2,257 veterans undergoing bariatric surgery in 2002-2011 and >7,000 non- surgical controls, we propose to address critical evidence gaps about 5-year post-surgical rates of AM, OUD and depression treatment in four specific aims: Aim 1: Examine long-term trends in the prevalence of AM (based on a validated screen) among bariatric surgery patients and matched non-surgical patients with and without a history of recognized AM. Aim 2: Examine long-term change in prescription opioid misuse among bariatric surgery patients and matched patients with and without opioid misuse at baseline. Aim 3: Examine long-term rates of depression treatment among bariatric surgery patients and matched patients with and without depression treatment at baseline. Aim 4: Examine whether baseline AM, prescription opioid use, and depression treatment moderate the effect of bariatric surgery on long-term weight change. Secondary Aim: Examine whether long-term changes in AM, prescription opioid use and depression treatment after surgery differ by patients undergoing RYGB, AGB or VSG.