Post-RYGB outcomes among those with and without current
substance use disorders: A matched controlled study.
Melissa E. Pulcini1, Karen K. Saules1, & Leslie M. Schuh2
1
Eastern Michigan University, Department of Psychology, Ypsilanti, MI
2
St. Vincent Bariatric Center of Excellence, Carmel, IN
Results
Introduction
Method
Control group (cont)
Measures
Control participants (those with a history
of RYGB but not postoperative SUDs)
were recruited for the present study.
Potential control participants were
identified using a database from St.
Vincent Bariatric Center of Excellence
by matching with the SUDs participants
on sex, age, and time since surgery.
Quality of Life
2.69 (0.93)
3.46 (1.21)
80
70
60
50
40
30
20
10
0
*
*
*
Postoperative SUD (controls only)
World Health Organization Alcohol,
Smoking and Substance Involvement
Screening Test Version 3.0 (WHOASSIST V3.0)
Control Group (n=26)
80.8%
96.2%
49.77 (8.09)
7.63 (2.97)
53.48 (8.74)
Physical
Psychological
Social
Domain
14.5
Environmental
_____
34.7%
34.6%
11.5%
%EWL
%Total body weight loss
Surgical Failure
7.0
6
3
SUD group
Major Depressive Disorder (MDD) Prevalence
Preliminary evidence suggests that RYGB surgery patients may be at an elevated risk for
SUD during the postoperative period (e.g., King et al., 2012; Saules et al., 2010). As the
number of bariatric surgery patients increase, so does this postoperative SUD subpopulation and the importance of understanding the nature of its weight loss and psychosocial
outcomes, as well as its unique treatment needs.
Following bariatric surgery, patients find themselves abruptly confronted with an inability to eat, but perhaps limited resources for managing food urges through other means, which can create conditions that foster drug and/or alcohol dependence.
The present study found that post-RYGB patients in inpatient treatment for SUDs fared at
least as well as post-RYGB controls in regard to weight loss but evidenced poorer quality
of life and greater symptoms of depression.
______________________
*
9
0
38.2%
Discussion
12
Note. * p= .001.
66.5%
Note. * p=.048.
Depression
15
74.4%
*
Global rating item 2: How satisfied
are you with your health? *
80
70
60
50
40
30
20
10
0
Control group
_
4.31 (0.84)
Depressive Symptoms
Patient Health Questionnaire- 9 (PHQ-9;
Spitzer et al., 1999)
Participant characteristics
Gender (% female)
Race (% White)
Age
Time since Surgery (yrs)
Preoperative BMI (kg/m²)
2.62 (1.20)
World Health Organization Quality of
Life-BREF (WHOQOL-BREF)
SUD Group (n=26)
80.8%
92.3%
48.04 (8.31)
6.76 (2.76)
54.29 (12.02)
Control group
Note. Data are presented as M (SD). Global rating items range from scores of 1 through 5, with higher scores
indicating better quality of life. Transformed domain scores range from 0 to 100, with higher scores indicating
better quality of life. * p<.05.
Depression
Control group
SUD group
__
Data from a previous study (Saules et.
al., 2010) were used. Briefly, inpatients
with one or more SUDs being treated at
a substance abuse treatment facility in
Brighton, Michigan were screened for a
history of RYGB during a routine
medical
interview
upon
intake.
Interested individuals with a history of
RYGB were recruited into the study.
Control Group (n=26)
Global rating item 1: How would you
rate your quality of life? *
__
SUD group
Matched individuals were contacted
about the study via postal mail. Those
endorsing problematic substance use
during the postoperative period were
excluded from the analyses.
SUD Group (n=26)
Mean PHQ-9 score
Procedures and
Recruitment
SUD group
Mean scores of WHOQOL-BREF global items and transformed domains
_
The present study compared questionnaire data from 26 SUD inpatients with a
history of RYGB surgery with data from 26 controls with a history of RYGB surgery
and absence of problematic postoperative substance use. For closer group comparison, controls were matched on three variables that have been linked to weight loss,
depression, and/or quality of life outcomes in RYGB patients: sex, age, and time
lapse since surgery.
Differences between the SUD and control groups in mean %EWL (74.4±22.1 vs. 66.5±27.6,
respectively) and mean percent total body weight change (-38.2±11.8 vs. -34.7±15.0,
respectively) were not statistically significant. Members of the control group were, however,
more likely to meet surgical failure criteria than members of the SUD group. Surgical failure
was defined as < 50 %EWL.
Quality of Life
Mean score
Our work suggests that post-Roux-en-Y gastric bypass (RYGB) patients are
overrepresented in the inpatient substance abuse treatment population (Saules et
al., 2010). However, little is known about how the surgical outcomes of these
individuals differ from RYGB patients who do not experience substance use
disorders (SUD) in the postoperative period.
Weight Loss
Control group
Twenty-two of the 26 individuals (84.6%) in the SUD group met the PHQ-9 10+ point criteria
for probable MDD, compared with five out of the 26 (19.2%) control participants. The
difference in frequency between groups was significant, X2 (1, 52) = 22.3, p< .001.
Expectation for improvement in quality of life is a common reason for seeking bariatric
surgery (Munoz et al., 2007). The present study has shown that SUD is associated with
poorer quality of life among post-RYGB patients. Bariatric surgery candidates should be
educated on conditions that compromise postoperative quality of life, as well as the risk
factors for, and likelihood of, developing these conditions.
Contrary to the present study’s weight loss findings, a recent study of a community sample
of post-bariatric surgery patients found that the presence of postoperative SUD predicted
poorer weight loss and that this effect persisted after controlling for eating-related variables
(Reslan, Saules, & Schuh, 2012). It is possible that this discrepancy may be due to the
likely attenuation of SUD severity of individuals in the community sample relative to that of
individuals in the present study. The appetite suppression effect of chronic substance use
may be greater in those with more severe SUDs. Future research is needed to clarify the
relationship between weight loss and SUD in the postoperative period.
PostPres
Presented at the 2012 Annual Meeting of The Obesity Society
Contact information: mpulcini@emich.edu