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Background & Aims: Bariatric surgery is common, but alcohol misuse has been reported following these procedures. We aimed to determine if bariatric surgery is associated with increased risk of alcohol‐related cirrhosis (AC) and alcohol misuse. Methods: Retrospective observational analysis of obese adults with employer‐sponsored insurance administrative claims from 2008 to 2016. Subjects with diagnosis codes for bariatric surgery were included. Primary outcome was risk of AC. Secondary outcome was risk of alcohol misuse. Bariatric surgery was divided into before 2008 and after 2008 to account for patients who had a procedure during the study period. Cox proportional hazard regression models using age as the time variable were used with interaction analyses for bariatric surgery and gender. Results: A total of 194 130 had surgery from 2008 to 2016 while 209 090 patients had bariatric surgery prior to 2008. Age was 44.1 years, 61% women and enrolment was 3.7 years. A total of 4774 (0.07%) had AC. Overall risk of AC was lower for those who received sleeve gastrectomy and laparoscopic banding during the study period (HR 0.4, P <.001; HR 0.43, P =.02) and alcohol misuse increased for Roux‐en‐Y and sleeve gastrectomy recipients (HR 1.86 and 1.35, P <.001, respectively). In those who had surgery before 2008, women had increased risk of AC and alcohol misuse compared to women without bariatric surgery (HR 2.1 [95% CI: 1.79‐2.41] for AC; HR 1.98 [95% CI 1.93‐2.04]). Conclusions: Bariatric surgery is associated with a short‐term decreased risk of AC but potential long‐term increased risk of AC in women. Post‐operative alcohol surveillance is necessary to reduce this risk. [ABSTRACT FROM AUTHOR]

Background: The burden of alcohol‐associated cirrhosis (AC) is high, and though alcohol cessation improves mortality, many patients fail to engage in alcohol use disorder (AUD) treatment and continue drinking. Our aim was to determine rates, predictors, and outcomes of AUD treatment utilization in AC patients with private insurance. Methods: We collected data from persons with AC (diagnosed by ICD‐9/ICD‐10 codes), aged 18 to 64 years, enrolled in the Truven MarketScan Commercial Claims and Encounters database (2009 to 2016). We determined rates and predictors of substance abuse treatment visits as well as rates of alcohol relapse prevention medication prescriptions, weighted to the national employer‐sponsored insured population. Effects of AUD treatment utilization on decompensation rates were calculated using proportional hazards regression with propensity score adjustment. Results: A total of 66,053 AC patients were identified, 32% were female, and mean age at diagnosis was 54.5 years. About 72% had insurance coverage for substance abuse treatment. Overall, AUD treatment utilization rates were low, with only 10% receiving a face‐to‐face mental health or substance abuse visit and only 0.8% receiving a Food and Drug Administration (FDA)‐approved relapse prevention medication within 1 year of index diagnosis. Women were less likely to receive a face‐to‐face visit (hazard ratio [HR] 0.84, p < 0.001) or an FDA‐approved relapse prevention medication (0.89, p = 0.05) than men. AC patients who had a clinic visit for AUD treatment or used FDA‐approved relapse medication showed decreased risk of decompensation at 1 year (HR 0.85, p < 0.001 for either). Conclusions: AUD treatment utilization is associated with lower decompensation rates among privately insured patients with AC. Women were less likely to utilize AUD treatment visits. Efforts to reduce gender‐specific barriers to treatment are urgently needed to improve outcomes. Access to alcohol use treatment is critical for those with alcohol‐associated liver disease as alcohol cessation improves outcomes. In this study of a large population of privately insured US adults with alcohol‐associated cirrhosis, access to alcohol use treatment was low, and access to all forms of alcohol use treatment was lower in women compared to men. Those who received treatment were less likely to experience symptoms of cirrhosis. Future studies should determine how to improve rates of alcohol use treatment for those with alcohol‐associated cirrhosis. [ABSTRACT FROM AUTHOR]