Rates of de novo alcohol use disorder and de novo high-risk alcohol use after bariatric surgery: a systematic review and meta-analysis.
Source: PubMed, NCBI / U.S. National Library of Medicine
Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are among the most performed bariatric surgeries. Increased alcohol use has been reported after metabolic and bariatric surgery although data is conflicting, and the incidence of alcohol use disorders (AUDs) by type of intervention is unknown. To assess the rates of de novo AUD and de novo high-risk alcohol use after metabolic and bariatric surgery and assess differences among the common procedures. University Hospital, USA METHODS: MEDLINE and Embase were searched through March 23, 2025 for studies reporting alcohol use after metabolic and bariatric surgery. Study bias was assessed using the Grading of Recommendations Assessment, Development, and Evaluation and Newcastle-Ottawa scales. The primary outcome was the pooled event rate for de novo AUD and de novo high-risk alcohol use after metabolic and bariatric surgery. Heterogeneity was considered substantial if I>50%, and this was investigated further by meta-regression and subgroup analyses. Secondary outcomes included rates of de novo AUD/high-risk alcohol use pre- and post-metabolic and bariatric surgery. Fifty-four studies including 934,824 patients were included. The incidence of de novo AUD/high-risk alcohol use after any metabolic and bariatric surgery was 2.49% (95% confidence interval [CI] 2.34-2.65, P = .001). The RYGB group had higher rates compared to those who underwent any other surgeries (1.48%, 95%CI 1.32-1.65, P = .01) and compared to those post-SG
Abstract
Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are among the most performed bariatric surgeries. Increased alcohol use has been reported after metabolic and bariatric surgery although data is conflicting, and the incidence of alcohol use disorders (AUDs) by type of intervention is unknown. To assess the rates of de novo AUD and de novo high-risk alcohol use after metabolic and bariatric surgery and assess differences among the common procedures. University Hospital, USA METHODS: MEDLINE and Embase were searched through March 23, 2025 for studies reporting alcohol use after metabolic and bariatric surgery. Study bias was assessed using the Grading of Recommendations Assessment, Development, and Evaluation and Newcastle-Ottawa scales. The primary outcome was the pooled event rate for de novo AUD and de novo high-risk alcohol use after metabolic and bariatric surgery. Heterogeneity was considered substantial if I>50%, and this was investigated further by meta-regression and subgroup analyses. Secondary outcomes included rates of de novo AUD/high-risk alcohol use pre- and post-metabolic and bariatric surgery. Fifty-four studies including 934,824 patients were included. The incidence of de novo AUD/high-risk alcohol use after any metabolic and bariatric surgery was 2.49% (95% confidence interval [CI] 2.34-2.65, P = .001). The RYGB group had higher rates compared to those who underwent any other surgeries (1.48%, 95%CI 1.32-1.65, P = .01) and compared to those post-SG (.77%, 95% CI .60-.96, P < .001), but differences were not significant when the analyses were limited to studies with direct comparisons of procedure types. The odds of de novo AUD/high-risk alcohol use increased postsurgery in the RYGB cohort (odds ratio [OR] 1.81, 95% CI 1.06-3.08, P = .03) but not in the other surgery (OR .78, 95% CI .41-1.49 P = .45) or SG cohort (OR .67, 95% CI .14-3.08, P = .60). De novo AUD and high-risk alcohol use appear to increase after both RYGB and SG, with no clear difference between procedures. Interpretation is limited by heterogeneous outcomes and predominantly retrospective data.