What is the clinical evidence from this study?

Study design: Cohort. Population: Obesity (post-bariatric surgery) (n=17800). Intervention: Roux-en-Y gastric bypass (RYGB) vs. Sleeve gastrectomy (SG). Primary outcome: New onset alcohol-related diagnosis (incidence rate per 1000 person-years) (HR 1.69, 95% CI 1.33-2.13, p=<0.001).

What question did this study set out to answer?

The study aims to compare the rates of alcohol use disorder and related morbidity and mortality between Roux-en-Y gastric bypass and sleeve gastrectomy.

June 18, 2026International Journal of Obesity1 citationsOpen Access

Alcohol use disorders and related morbidity and mortality after sleeve gastrectomy and Roux-en-Y gastric bypass: a nation-wide registry study (the BAR-REGISTER)

Q: What are the key findings of this study?

Compared with sleeve gastrectomy, Roux-en-Y gastric bypass was associated with a 69% higher risk of new onset alcohol-related diagnoses (HR 1.69).

Q: What question did this study set out to answer?

The study aims to compare the rates of alcohol use disorder and related morbidity and mortality between Roux-en-Y gastric bypass and sleeve gastrectomy.

MSMagnus StrømmenNorwegian University of Science and Technology IBInger Johanne BakkenNorwegian Institute of Public Health JSJorunn SandvikNorwegian University of Science and Technology

Key Result

Compared with sleeve gastrectomy, Roux-en-Y gastric bypass was associated with a 69% higher risk of new onset alcohol-related diagnoses (HR 1.69).

Key Points

The study aims to compare the rates of alcohol use disorder and related morbidity and mortality between Roux-en-Y gastric bypass and sleeve gastrectomy.
Retrospective, population-based cohort study using data from the Norwegian Patient Registry and Prescription Database.
Included 17,800 patients who underwent RYGB or SG between 2008 and 2018, excluding those with prior alcohol-related diagnoses.
Calculated incidence rates of alcohol-related diagnoses per 1000 person-years and derived hazard ratios comparing RYGB with SG.
3.2% of patients developed new alcohol-related diagnoses with an incidence rate of 6.34 per 1000 person-years.
Adjusted hazard ratio for alcohol-related diagnoses was 1.69 (95% CI 1.33–2.13, p < 0.001) for RYGB compared to SG.
Patients with alcohol-related diagnoses had a twofold increased risk of death (adjusted HR 2.08, 95% CI 1.40–3.08) relative to those without.

Study Design

Type

Cohort (n=17,800)

Multicenter

Yes

Structured PICO

Does Roux-en-Y gastric bypass increase the risk of alcohol use disorder compared to sleeve gastrectomy in patients undergoing bariatric surgery?

Population

17,800 patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy, free of prior alcohol-related diagnoses, followed for an average of 3.8 to 5.7 years.

Exposure

Roux-en-Y gastric bypass (RYGB)

Comparator

Sleeve gastrectomy (SG)

Outcome

Incidence of new alcohol-related diagnosessafety

Roux-en-Y gastric bypass is associated with a significantly higher risk of developing alcohol use disorders compared to sleeve gastrectomy, which in turn is linked to increased morbidity and mortality.

Main Result

Hazard Ratio: 1.69 (95% CI 1.33–2.13)

Absolute Event Rate: 7.07% vs 3.95%

p-value: p=<0.001

Limitations

Registry-based ascertainment underestimates true incidence of alcohol use disorders.
Did not include naltrexone in the prescription data.
Observational nature of the design precludes definitive conclusions about causality.
Lack of a surgical control group undergoing an operation not expected to alter ethanol kinetics.

Abstract

Abstract Background Bariatric surgery provides notable weight loss and metabolic benefits but may also increase the risk of alcohol use disorder (AUD). We investigated whether Roux-en-Y gastric bypass (RYGB) confers higher rates of AUD and related disorders than sleeve gastrectomy (SG) and examined associated morbidity and mortality. Methods We conducted a retrospective, population-based cohort study using data from the Norwegian Patient Registry and the Norwegian Prescription Database. A total of 17,800 patients underwent RYGB ( n = 12,244) or SG ( n = 5556) between 2008 and 2018. Patients with prior diagnoses related to alcohol or use of medications for AUD were excluded. Incidence rates (IR) for alcohol-related diagnoses were calculated per 1000 person-years; hazard ratios (HR) were derived comparing RYGB to SG. Morbidity was measured as number of specialized healthcare contacts, but also as number of prescriptions/defined daily doses in an exploratory model. Results Mean postoperative follow-up was 5.7 years (RYGB) and 3.8 years (SG). By 31 December 2018, 576 patients (3.2%) had developed a new alcohol-related diagnosis – an incidence rate of 6.34 per 1000 person-years. The adjusted HR for such diagnoses was 1.69 (95% CI 1.33–2.13, p < 0.001) for patients undergoing RYGB compared to SG. Because mortality did not differ significantly between RYGB and SG, mortality was assessed for the cohort as a whole: patients with alcohol-related diagnoses had an adjusted HR for death of 2.08 (95% CI 1.40–3.08) relative to those without. They also recorded, on average, 5.5 additional contacts in specialist care. Conclusions Compared with SG, RYGB was associated with a 69% higher risk of alcohol-related diagnoses. Further, given the elevated morbidity and mortality linked to these disorders, enhanced preoperative screening and long-term postoperative monitoring are warranted in modern bariatric practice.

问 AI

Bookmark

View Full Paper