Association between attention deficit hyperactivity disorder and outcomes after metabolic and bariatric surgery: a nationwide propensity-matched cohort study |
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| Affiliation: | 1. Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden;2. School of Medical Sciences, Örebro University, Örebro, Sweden;3. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden;4. Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden;5. Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden;6. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden |
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| Abstract: | BackgroundThe risks and benefits of metabolic and bariatric surgery for patients with attention deficit hyperactivity disorder (ADHD) remain to be investigated.ObjectiveThe aim of this study was to assess short- and long-term outcomes after metabolic and bariatric surgery in patients with previous ADHD compared with matched control individuals.SettingRegistry based.MethodsThis 2-staged matched-cohort study included all adults with a body mass index of ≥30 kg/m2 who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy from 2007 until 2017 registered in the Scandinavian Obesity Surgery Registry. Patients with prescribed medication for ADHD were matched with control individuals without ADHD with a follow-up of up to 11 years after surgery.ResultsAmong 1431 patients with ADHD and 2862 control individuals (mean body mass index, 42 kg/m2; mean age, 35 years), no difference in weight loss or follow-up attendance over 2 years was seen. ADHD was associated with a higher risk for early postoperative complications (odds ratio [OR] = 1.31; 95% confidence interval [CI], 1.05–1.63), self-harm (hazards ratio [HR] = 1.39; 95% CI, 1.11–1.75), and substance abuse (HR = 1.34; 95% CI, 1.16–1.55), while associations with overall mortality (HR = 1.42; 95% CI, .99–2.03), major adverse cardiovascular and cerebrovascular events (HR = 1.93; 95% CI, .98–3.83), and effects on obesity-related diseases were uncertain. ADHD was associated with a lower health-related quality of life in all aspects before surgery. These differences increased for mental and obesity-related aspects but remained unchanged over time for physical aspects.ConclusionsCompared with patients without ADHD, patients treated pharmacologically for ADHD experience similar weight loss and remission of obesity-related diseases without an increased risk for serious complications but report a lower health-related quality of life and have an increased risk of substance abuse and self-harm. This further emphasizes the need for close follow-up care for this group of individuals |
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| Keywords: | Attention deficit hyperactivity disorder Obesity Bariatric surgery Postoperative outcome Psychiatric disorder |
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