medwireNews: People with osteoarthritis (OA) and obesity who undergo bariatric surgery are less likely to require long-term analgesic prescriptions and have a lower mortality risk than those who do not, researchers report.
These findings are based on an analysis of 588,494 individuals with OA and a BMI of at least 35 kg/m2 who attended a UK primary care practice in 2000–2018 and were included in The Health Improvement Network database.
Guanghua Lei (Central South University, Changsha, China) and colleagues found that 52.2% of the 694 people who underwent bariatric surgery received a prescription for nonsteroidal anti-inflammatory drugs, opioids, or acetaminophen (paracetamol) during a mean follow-up of 2.19 years, compared with 62.0% of the 587,800 who did not during a mean follow-up of 3.24 years.
Inverse probability weighting was used to balance potential confounders between the two groups, and people in the bariatric surgery group were significantly more likely to have no analgesic prescription for at least 12 consecutive months than those in the control group, with rates of 238.2 and 191.5 per 1000 person–years, respectively, and a hazard ratio (HR) of 1.23.
Lei and team note in Osteoarthritis and Cartilage that this difference was “more pronounced” in the 247 people who lost at least 20% of their bodyweight following bariatric surgery (HR=1.43), but was no longer significant in those with less substantial weight loss.
The researchers also demonstrated significantly lower rates of all-cause mortality among people who underwent bariatric surgery than those in the control group, at 6.9 versus 24.1 per 1000 person–years (HR=0.46), and this remained consistent in a sensitivity analysis excluding individuals with ischemic heart disease, chronic kidney disease, or cancer.
These findings suggest that “bariatric surgery may be considered as one alternative treatment strategy for certain [severely] obese patients with OA,” write Lei et al.
They acknowledge, however, that the protective association “may be overestimated owing to intractable confounding by indication for bariatric surgery,” and the study was not able to measure over-the-counter analgesic purchases, meaning that overall rates of use “may be underestimated.”
Therefore, “future studies (e.g., clinical trials) are warranted,” concludes the team.
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Osteoarthritis Cartilage 2021; doi:10.1016/j.joca.2021.05.063