Nav: Home

Weight-loss patients at higher risk of death from substance use disorders

June 07, 2019

PITTSBURGH, June 7, 2019 - The death rate from drug- and alcohol-related causes in people who've had Roux-en-Y gastric bypass surgery is nearly triple that of the general public, according to University of Pittsburgh research published today in Surgery for Obesity and Related Diseases, the journal of the American Society for Metabolic and Bariatric Surgery.

The study also found that fewer than half of those who died had triggered a safety protocol for problematic substance use. Only one of those who died was known to have received treatment for substance use disorder.

"Increasingly with bariatric surgery patients, we're finding that the tools that clinicians traditionally use to screen for drug or alcohol problems don't work well to identify those at risk," said lead author Gretchen White, Ph.D., epidemiologist in the Pitt School of Medicine's Department of Surgery. "These deaths are an extreme and sad example of a problem that needs to be addressed."

For seven years, White and her colleagues followed 2,458 adults who underwent bariatric surgery. The participants were enrolled in the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective, observational study of patients undergoing weight-loss surgery at one of 10 hospitals across the United States.

Reflecting typical bariatric surgery patients, the majority of study participants were female (79%) and white (86%). At time of surgery, the median age was 46 years old. During the seven-year follow-up, 10 of the participants died of causes directly related to drug- and alcohol-use, with six unintentional drug overdoses, one intentional overdose, one overdose where the intent was unknown and two deaths from alcoholic liver disease. All 10 participants had undergone Roux-en-Y gastric bypass surgery, which reduces the size of the stomach and shortens the intestine, and accounted for 72% of the bariatric procedures in the study sample.

The team looked at the deaths in terms of "person-years," a scientific measure that takes into account both the number of people in a study and the amount of time each person spends in the study. The drug- and alcohol-related death rate was 89 deaths per 100,000 person-years for the Roux-en-Y gastric bypass surgery patients, compared to 30.5 deaths per 100,000 person-years for the general population matched on age, sex, race and calendar year. On average, the deaths occurred nearly five years post-surgery.

"While drug- and alcohol-related deaths were too rare to identify risk factors, it is noteworthy that the demographics of those who died were similar to the full sample. Based on demographics, bariatric surgery patients should be a low-risk group for substance-related death," said senior author Wendy King, Ph.D., associate professor in the Pitt Graduate School of Public Health's Department of Epidemiology. "Laboratory studies indicate that Roux-en-Y gastric bypass changes the way the body reacts to alcohol and drugs, and our previous work demonstrates an increased risk of self-reported problematic alcohol use and illicit drug use following this surgery. This study indicates such problems can lead to loss of life."

In addition to research to better understand the reasons for the high death rate, the scientists suggest that new clinical screening tools, tailored specifically to bariatric surgery patients, are needed so clinicians can better detect patients at high risk for substance use problems.

For example, White says, current questionnaires ask people about the number and frequency of alcoholic beverages they consume. Because bariatric surgery patients tend to experience the effects of alcohol faster and with fewer drinks than the average person, it might be better to ask about how alcohol makes them feel, if it is interfering with daily activities and whether they or their families and friends think they may have a problem.

Because the deaths occurred many years after surgery, co-author Anita Courcoulas, M.D., chief of minimally invasive bariatric surgery at UPMC, said that it is especially important that primary care physicians be aware of the particular risks that bariatric surgery patients face in terms of substance use.

"This is an important issue to recognize in all bariatric surgery patients as there is a clear signal of risk for substance use-related deaths," said Courcoulas. "Further study is required to understand the precise mechanisms, and prospective tracking of patients is very important to be able to offer more timely intervention."
-end-
This research was supported by a cooperative agreement funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Grant numbers are: Data Coordinating Center - U01 DK066557; Columbia-Presbyterian - U01-DK66667 (in collaboration with Cornell University Medical Center CTSC, grant UL1-RR024996); University of Washington - U01-DK66568 (in collaboration with CTRC, grant M01RR-00037); Neuropsychiatric Research Institute - U01-DK66471; East Carolina University - U01-DK66526; UPMC - U01-DK66585 (in collaboration with CTRC, grant UL1-RR024153); and Oregon Health & Science University - U01-DK66555.

To read this release online or share it, visit http://www.upmc.com/media/news/060719-whiteking-sud-mortality.

About the University of Pittsburgh Schools of the Health Sciences

The University of Pittsburgh Schools of the Health Sciences include the schools of Medicine, Nursing, Dental Medicine, Pharmacy, Health and Rehabilitation Sciences and the Graduate School of Public Health. The schools serve as the academic partner to the UPMC (University of Pittsburgh Medical Center). Together, their combined mission is to train tomorrow's health care specialists and biomedical scientists, engage in groundbreaking research that will advance understanding of the causes and treatments of disease and participate in the delivery of outstanding patient care. Since 1998, Pitt and its affiliated university faculty have ranked among the top 10 educational institutions in grant support from the National Institutes of Health. For additional information about the Schools of the Health Sciences, please visit http://www.health.pitt.edu.

http://www.upmc.com/media

Contact: Allison Hydzik
Office: 412-647-9975
Mobile: 412-559-2431
E-mail: HydzikAM@upmc.edu

Contact: Madison Brunner
Office: 412-578-9193
Mobile: 412-432-8390
E-mail: BrunnerM@upmc.edu

University of Pittsburgh

Related Bariatric Surgery Articles:

Probing problems with bariatric surgery: Reoperations, variation are common
Every year, nearly 200,000 Americans turn to surgeons for help with their obesity, seeking bariatric surgery to lose weight and prevent life-threatening health problems.
Bariatric surgery impacts joint replacement outcomes in very obese patients
A study from Hospital for Special Surgery finds that in morbidly obese patients, bariatric surgery performed prior to a total hip or knee replacement can reduce in-hospital and 90-day postoperative complications and improve patient health, but it does not reduce the risk of needing a revision surgery.
Study will determine which type 2 diabetes patients benefit most from bariatric surgery
Bariatric surgery can reverse type 2 diabetes. But which patients with type 2 diabetes will benefit most from surgery?
Bariatric surgery may reduce heart failure risk
Bariatric surgery and other treatments that cause substantial weight loss can significantly reduce the risk of heart failure in obese patients.
Is bariatric surgery a cost-effective treatment for teens with severe obesity?
In a study published online by JAMA Surgery, Chin Hur, M.D., M.P.H., of Massachusetts General Hospital, Boston, and colleagues assessed the cost-effectiveness of bariatric surgery for adolescents with obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery study.
Shorter-time between bariatric surgery and childbirth associated with increased risk of complication
Infants who were born less than two years after a mother's bariatric surgery had higher risks for prematurity, neonatal intensive care unit admission, and small for gestational age status compared with longer intervals between bariatric surgery and childbirth, according to a study published online by JAMA Surgery.
Study examines work status, productivity after bariatric surgery
In a study appearing in the Oct. 18 issue of JAMA, David R.
Weight loss following bariatric surgery sustained long-term
Obese patients who underwent Roux-en-Y gastric bypass (RYGB) lost much more weight than those who did not and were able to sustain most of this weight loss 10 years after surgery, according to a study published online by JAMA Surgery.
Bariatric surgery associated with improved mobility, less walking pain
Does bariatric surgery for severely obese teens help them gain better mobility and reduce musculoskeletal pain?
Weight loss from bariatric surgery appears to reverse premature aging
Weight loss from bariatric surgery appears to reverse the premature aging associated with obesity, according to research presented today at Frontiers in CardioVascular Biology 2016.1 Patients had longer telomeres and less inflammation two years later.

Related Bariatric Surgery Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...