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Bariatric surgery may spur an unhealthy relationship with drinking in the years after surgery, a study of military veterans suggested.

In the retrospective analysis of data from the U.S. Department of Veterans Affairs (VA), veterans who didn't have an unhealthy relationship with alcohol 2 years prior to laparoscopic sleeve gastrectomy had a higher probability of unhealthy alcohol use 8 years after surgery compared with nonsurgical controls (7.9% vs 4.5%; difference 3.4%, 95% CI 1.8-5.0), reported Matthew Maciejewski, PhD, of Durham VA Medical Center in North Carolina, and colleagues.

Following a similar pattern, veterans with no alcohol use issues 2 years prior to Roux-en-Y gastric bypass (RYGB) surgery saw a higher probability of developing an unhealthy relationship with drinking 8 years later versus nonsurgical controls (9.2% vs 4.4%, difference 4.8%, 95% CI 3.6-5.9), they stated in .

For both procedures, patients saw an increased prevalence of unhealthy drinking over all postoperative years.

"From these findings, we estimate that for every 21 patients who undergo [RYGB] and every 29 patients who undergo [laparoscopic sleeve gastrectomy], on average 1 from each group will develop unhealthy alcohol use," Maciejewski's group pointed out, adding that "Alcohol-related risks were somewhat more pronounced after [RYGB] than [laparoscopic sleeve gastrectomy], potentially reflecting greater changes in alcohol pharmacokinetics associated with RYGB."

Veterans who underwent either type of bariatric surgery were also less likely to totally abstain from alcohol 5 to 8 years postoperative compared with nonsurgical controls.

And 8 years after sleeve gastrectomy, patients were nearly 10% (95% CI -13.1% to -6.4%) less likely to abstain from alcohol versus nonsurgical controls, while those who underwent RYGB were about 8% (95% CI -10.1% to -5.9%) less likely to be non-drinkers.

Average scores on the 3-item Alcohol Use Disorders Identification Test- Consumption (AUDIT-C) scale also increased after both types of bariatric surgeries, but not for nonsurgical comparators.

In a smaller sample of those who reported unhealthy alcohol use prior to surgery, RYGB patients had a 13% higher chance of continuing that unhealthy alcohol use 8 years after surgery than nonsurgical controls.

The retrospective cohort study included 1,539 veterans who underwent sleeve gastrectomy matched to 14,555 nonsurgical control patients, as well as 854 patients who underwent a gastric bypass matched to 8,038 nonsurgical control patients, none of whom reported unhealthy alcohol use at baseline. All surgical patients underwent their bariatric surgical procedure at any of the 130 bariatric centers in the VA health system between 2008 and 2016. Unlike most other , this cohort was composed of 75% men.

Calling this a "well-designed study" in an , Anne Fernandez, PhD, of the University of Michigan in Ann Arbor said that unhealthy alcohol use is often an overlooked outcome in bariatric surgery studies and ultimately an "iatrogenic complication of bariatric surgical procedures."

She explained that "bariatric surgical procedures represent a crossroad whereby a subset of patients transition from one pervasive and high-risk behavior to another, an iatrogenic outcome that affects patients, families, and society alike. In fact, the behaviors underlying obesity and unhealthy alcohol use (i.e., physical inactivity, bad diet, and alcohol use) represent the leading causes of preventable death in the United States."

Fernandez added that these findings reinforce the importance of pre- and postoperative alcohol education and counseling, but pointed out that preoperative alcohol screening isn't particularly useful in this scenario as Maciejewski's group found that patients across both surgery types cut back on alcohol use just prior to their procedure.

Instead, she suggested healthcare providers get creative, like putting flags in these patients' electronic health records (EHR) to monitor and screen them for alcohol issues in the years after surgery.

Study limitations included full reliance on alcohol screening through the VA EHR system, so unhealthy alcohol use may have been underestimated. Also, "because patients with unhealthy alcohol use often are not accepted for bariatric surgical procedures, self-reporting might be biased," the authors noted.

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