Study Highlights Importance of Pre-Operative Alcohol Screening
Alcohol misuse is one of several health behaviors that increase risk of post-operative morbidity. However, relatively little is known about the prevalence of alcohol misuse in different demographic and clinical subgroups of surgical patients, and no study has described the prevalence of alcohol misuse across surgical sub-populations, based on Alcohol Use Disorder Identification Test Consumption (AUDIT-C) questionnaire scores. This study evaluated the prevalence of alcohol misuse in a national sample of 10,284 Veterans (9,771 men and 513 women) who underwent major non-cardiac surgery in VA hospitals during FY04-FY06, and who had completed the AUDIT-C questionnaire as part of the Survey of Healthcare Experiences of Patients (SHEP) up to a year before surgery. Specifically, using VA data, investigators assessed the prevalence of screening positive for alcohol misuse at levels associated with increased risk of postoperative complications (AUDIT-C >5) among demographic subgroups, clinical subgroups defined by inpatient and outpatient diagnoses in the year prior to surgery, and patients undergoing specific surgical procedures.
- Among the Veterans in this study, 16% of men and 5% of women screened positive for alcohol misuse at levels associated with increased post-operative complications in the year before surgery.
- A majority of male and female surgical patients with alcohol misuse were relatively healthy and did not have diagnoses or chronic conditions commonly associated with alcohol misuse that might alert providers to their alcohol misuse. This finding highlights the value of routine pre-operative alcohol screening to proactively identify Veterans who misuse alcohol and to potentially implement interventions before surgery.
- Screening positive for alcohol misuse (AUDIT-C >5) was more common among men who were: younger than 60 years old, divorced or separated, current smokers, or ASA class 1-2 (pre-operative assessment by anesthesiologist as healthy patient or patient with mild systemic disease), and among men with cirrhosis, hepatitis, or substance use disorders.
- The AUDIT-C was completed up to one year prior to surgery and asked about alcohol use in the prior year. This may have overestimated the prevalence of alcohol misuse at the time of surgery because patients may have decreased alcohol use if they became ill.
- The AUDIT-C surgical risk groups used in this study were based on associations between AUDIT-C scores and post-operative complications in men, and may not reflect the appropriate AUDIT-C thresholds for risk in women.
This study was funded by HSR&D (IAC 06-021). Dr. Bradley is an Affiliate Investigator at HSR&D's Northwest Center for Outcomes Research in Older Adults in Seattle.
Bradley K, Rubinsky A, Sun H, et al. Prevalence of Alcohol Misuse among Men and Women Undergoing Major Non-Cardiac Surgery in the Veterans Affairs Health Care System. Surgery April 11, 2012;e-pub ahead of print.