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Journal Club

Journal Club. Alcohol, Other Drugs, and Health: Current Evidence July–August 2012. Featured Article. Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. King WC, et al. JAMA. 2012;307(23):2516–2525. Study Objective.

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Journal Club

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  1. Journal Club Alcohol, Other Drugs, and Health: Current Evidence July–August 2012

  2. Featured Article Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery King WC, et al. JAMA. 2012;307(23):2516–2525.

  3. Study Objective • To assess the prevalence of pre- and post-operative alcohol use disorders (AUDs) in patients who underwent bariatric surgery and identify predictors of post-operative AUD in these patients.

  4. Study Design • Prospective cohort study of adults who underwent bariatric surgery at 10 US hospitals. • Of 2458 participants, 1945 (79% female; 87% white; median age, 47 years; median body mass index [BMI], 46) completed preoperative (pre-op) assessments and postoperative (post-op) assessments at 1 and/or 2 years. • The main outcome measure was past-year AUD symptoms (Alcohol Use Disorders Identification Test [AUDIT] score ≥8).

  5. Assessing Validity of an Article About Harm • Are the results valid? • What are the results? • How can I apply the results to patient care?

  6. Are the Results Valid? • Did the investigators demonstrate similarity in all known determinants of outcomes? Did they adjust for differences in the analysis? • Were exposed patients equally likely to be identified in the two groups? • Were the outcomes measured in the same way in the groups being compared? • Was follow-up sufficiently complete?

  7. Did the investigators demonstrate similarity in all known determinants of outcomes? • Not applicable. • Case series design did not include an unexposed cohort. • Patients included in the analysis (compared with those excluded for failure to complete the AUDIT pre- or post-op) were older (median of 47 years versus 42 years), a greater percentage were white (87.0% versus 82.0%), and a smaller percentage were smokers (2.2% versus 4.1%). There were no significant differences between groups with respect to other characteristics.

  8. Did they adjust for differences in the analysis? • Results were adjusted for sex, age, smoking status, regular alcohol consumption, AUD pre-op, Interpersonal Support Evaluation List (ISEL-12) score, recreational drug use, surgical procedure used, and time (1st or 2nd year post-op).

  9. Were exposed patients equally likely to be identified in the groups? • Not applicable. • An unexposed group (no bariatric surgery) was not evaluated. 9

  10. Were the outcomes measured in the same way in the groups being compared? • Not applicable. • An unexposed group (no bariatric surgery) was not evaluated.

  11. What are the Results? • How strong is the association between exposure and outcomes? • How precise is the estimate of the risk?

  12. How strong is the association between exposure and outcome? How precise is the estimate of the risk? • More than half of those reporting AUD at the preoperative assessment continued to have or had recurrent AUD (66/106; 62.3% [95% CI, 53.0%–71.5%]). • Among participants not reporting AUD at the preoperative assessment, 7.9% (95% CI, 6.4%–9.4%; 101/1283) had postoperative AUD. • More than half (101/167; 60.5% [95% CI, 53.1%–67.9%]) of postoperative AUD was reported by those not reporting AUD at the preoperative assessment. 12

  13. How Can I Apply the Results to Patient Care? • Were the study patients similar to the patients in my practice? • Was the duration of follow-up adequate? • What was the magnitude of the risk? • Should I attempt to stop the exposure?

  14. Were the study patients similar to the patients in my practice? • The median BMI among participants was 46; the mean age was 47, 68% were employed, nearly 80% were women, and nearly 90% were white.

  15. Was the duration of follow-up adequate? • Data were available on the majority of subjects at 1 and 2 years post operatively, an adequate duration.

  16. What was the magnitude of the risk? • Among participants not reporting AUD at the preoperative assessment, 7.9% (95% CI, 6.4%–9.4%; 101/1283) had postoperative AUD. • More than half (101/167; 60.5% [95% CI, 53.1%–67.9%]) of postoperative AUD was reported by those not reporting AUD at the preoperative assessment.

  17. Should I attempt to stop the exposure? • Bariatric surgery, although not without risk, has been associated with health benefits including control of blood pressure and diabetes. • Based on this research, patients planning to undergo bariatric surgery should be advised of the risk of developing an AUD.

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