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Gastric Bypass Surgery and Substance Use Death

July 17th, 2019

Gastric bypass surgery, also called the Roux-en-Y gastric bypass procedure, is the most common form of weight loss surgery performed in the United States today and has helped many people lose weight and improve health. However, a new study reports that the death rate from drug- and alcohol-related causes in people who have had Roux-en-Y gastric bypass surgery is nearly triple that of the general public, according to recently published research from the University of Pittsburgh. 

Researchers followed 2,458 adults from 10 hospitals who had some type of weight loss surgery. 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 in which the intent was unknown, and two deaths from alcoholic liver disease. On average, the deaths occurred nearly five years post-surgery. 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 procedures in the study sample. According to senior author Wendy King, PhD, “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.”

The team also 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. 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.

In addition to research to better understand the reasons for the high death rate, the team suggests that new screening tools, tailored specifically to bariatric surgery patients, are needed so clinicians can better detect patients at high risk for substance use problems. “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, PhD. For example, current questionnaires ask people about the number and frequency of alcoholic beverages they consume. But 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. 

Learn more about Substance Use studies at Pitt+Me.