Medication Use Before and After Different Bariatric Surgery Procedures: Results from a Population-Based Cohort Study

Background: Metabolic and bariatric surgery improves most obesity-related comorbidities. Here, we evaluate the effect of different metabolic and bariatric surgery interventions on the use of medications to treat chronic conditions. Materials and Methods: This was an observational population-based cohort study performed in Lombardy, Italy. Healthcare utilization databases were used to identify all residents who underwent a metabolic and bariatric surgery procedure between 2010 and 2020 with available follow-up data for at least three years after surgery. We included patients undergoing laparoscopic sleeve gastrectomy (LSG), gastric bypass (GB), laparoscopic adjustable gastric banding (LAGB), and biliopancreatic diversion (BPD). Results: During the period 2010 to 2020, 19,450 patients (22.5% males, 13.5% with diabetes) underwent a metabolic and bariatric surgery procedure. LSG was the most commonly performed procedure (65%), followed by LAGB (19%), GB (15%), and BPD (1%). There was a significant reduction in the use of glucose-lowering and antihypertensive drugs after the procedure in all groups. Compared to LSG, the reduction in the use of glucose-lowering drugs was greater following GB (reduction at 3 years: 59 vs 65%, p-interaction < 0.001) and lower following LAGB (59 vs 25%, p-interaction < 0.001). There was a significant reduction in lipid-lowering drug use following LSG and GB (3-year reduction: 21 and 50%, p-interaction < 0.001), and in psychiatric drug use following LSG, GB, and LAGB (with no difference between groups). In all groups, proton pump inhibitor use increased during the first 6 months, followed by a decrease from 1 year afterward. Conclusion: The present study including a large number of patients undergoing metabolic and bariatric surgery procedures shows robust reductions in the use of glucose, blood pressure and lipid-lowering drugs at 3 years follow-up, suggesting benefits of surgery on both quality of life and healthcare costs.