Transcript 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.

Journal Club
Alcohol, Other Drugs, and Health: Current Evidence
July–August 2012
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Featured Article
Prevalence of Alcohol Use
Disorders Before and After
Bariatric Surgery
King WC, et al. JAMA. 2012;307(23):2516–2525.
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Study Objective
• To assess the prevalence of pre- and postoperative alcohol use disorders (AUDs) in
patients who underwent bariatric surgery and
identify predictors of post-operative AUD in
these patients.
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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).
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Assessing Validity of an
Article About Harm
• Are the results valid?
• What are the results?
• How can I apply the results to
patient care?
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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?
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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.
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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).
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Were exposed patients equally likely
to be identified in the groups?
• Not applicable.
- An unexposed group (no bariatric surgery) was
not evaluated.
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Were the outcomes measured in the
same way in the groups being compared?
• Not applicable.
- An unexposed group (no bariatric surgery)
was not evaluated.
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What are the Results?
• How strong is the association between
exposure and outcomes?
• How precise is the estimate of the risk?
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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.
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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?
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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.
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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.
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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.
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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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