Psychiatric Hospitalization Risk After Bariatric Surgery

Caroline Helwick

June 06, 2011

June 6, 2011 (Chicago, Illinois) — Patients who undergo bariatric surgery for weight loss are significantly more likely to be hospitalized for a psychiatric illness, both before and after the procedure, than the general population, according to a Swedish study presented here at Digestive Disease Week 2011.

In addition, patients who undergo gastric bypass surgery have a 2-fold increased risk postoperatively for inpatient treatment for alcohol abuse, compared with patients who have restrictive surgery, reported Magdalena Plecka Östlund, MD, from the Karolinska Institutet in Stockholm, Sweden.

"Patients undergoing gastric bypass should be carefully counseled on alcohol consumption," she suggested. "In addition, caregivers should be aware of the greater potential for alcohol abuse after surgery so that treatment can be sought if problems arise."

Population-based studies have found that obese people are more likely than the general population to suffer from mood and anxiety disorders, and there are reports that gastric bypass patients are overrepresented in substance abuse treatment programs, she noted. Her study explores these possible associations.

The study was a retrospective cohort study of all 12,277 patients who underwent antiobesity surgery in Sweden between 1980 and 2006, and a matched control cohort of 122,770 people sampled from the general population. The primary surgical procedures were gastric bypass, vertical banded gastroplasty, and gastric banding, and they occurred in almost equal proportions.

The mean age of the patients at operation was 40 years, and the mean follow-up time was about 9 years.

Compared with the general population, the bariatric population was significantly more likely to be treated for depression (hazard ratio [HR], 1.9), attempted suicide (HR, 2.7), substance abuse (HR, 2.7), and alcoholism (HR, 1.7) before surgery, Dr. Östlund reported.

The lack of association with psychosis was seen both with gastric bypass surgery and restrictive procedures. However, both types of intervention were associated with hospitalization for a psychiatric disorder.

In the gastric bypass surgery cohort, the hazard ratio was 3.8 for substance abuse, 4.1 for suicide attempt, 4.0 for alcohol abuse, and 2.4 for depression. For the restrictive surgery cohort, these hazard ratios were, respectively, 1.4, 2.4, 1.2, and 1.8.

Especially notable was the difference in inpatient treatment for alcoholism after gastric bypass surgery, she said. Prior to bariatric surgery, there was no difference in inpatient treatment for alcoholism between patients undergoing gastric bypass and those undergoing a restrictive procedure. After surgery, the gastric bypass patients had a 2.3-fold greater risk of being hospitalized for alcoholism, the researchers found. The bypass group also had a 2.5-fold greater risk of being treated for a substance abuse disorder.

Dr. Östlund reminded listeners that bariatric surgery has many health benefits, and the risk for alcoholism should be viewed in context of these.

She suggested that the study's strength was that it was a nationwide sample, with findings based on comprehensive registry data. "But we had no data on weight development, and different selection criteria may have been applied for the different procedures," she noted.

"Still, we can conclude that the total bariatric surgery cohort had an increased risk of inpatient treatment for the psychiatric disorders we studied," she said.

Vivek N. Prachand, MD, codirector of the Center for the Surgical Treatment of Obesity at the University of Chicago Pritzker School of Medicine, Illinois, commented that the study might be "comparing apples and oranges" in comparing the bariatric population with a normal-weight healthy population.

A better comparison would be the bariatric population with a very obese population not undergoing weight-loss surgery, Dr. Prachand suggested. "It could be that the differences you found might be seen in a morbidly obese population in general. The differences may not be reflecting the surgery treatment," he suggested.

Dr. Östlund and Dr. Prachand have disclosed no relevant financial relationships.

Digestive Disease Week (DDW) 2011: Abstract 266. Presented May 7, 2011.

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