Alcohol Screening Results Up to One Year Prior to Surgery Associated with Increased Post-Operative Complications for Veterans
Surgical patients who consume more than four drinks daily have a 2-3 fold increased risk of post-operative complications compared to patients who drink less than two drinks daily. However, one month of pre-operative abstinence significantly decreased post-operative complications in a study of surgical patients who drank more than four drinks daily. Early identification of patients who might benefit from pre-operative abstinence requires a practical way to identify those at risk for alcohol-related surgical complications. Therefore, this study evaluated whether results of alcohol screening with the AUDIT-C (Alcohol Use Disorders Identification Test – Consumption), administered up to one year before surgery, were associated with the risk of post-operative complications in Veterans undergoing major non-cardiac surgery in VA. Using data from VA’s Surgical Quality Improvement Program (VASQIP) from FY04-FY06, investigators identified 9,176 male Veterans that had major non-cardiac surgery in one of 106 VA facilities – and had completed the AUDIT-C screening questionnaire on a mailed survey within one year before surgery. The main outcome measure in this study was any post-operative complication within 30 days of surgery.
Findings showed that AUDIT-C scores of 5 or higher up to one year before surgery were associated with increased post-operative complications. Overall, 16% of the total study population screened positive for alcohol misuse with AUDIT-C scores >5, and 8% had post-operative complications. There also was a dose-response relationship between AUDIT-C scores and post-operative complications, with complications increasing from 6% among low-risk drinkers to 14% among Veterans with the highest AUDIT-C scores. Those who screened positive for alcohol misuse with high AUDIT-C scores (9-12) also had greater comorbidity than drinkers with lower AUDIT-C scores. The authors suggest that AUDIT-C scores could be electronically loaded into surgery consults, surgery clinic notes, or pre-operative templates in VA’s computerized patient record system in order to alert clinicians to alcohol misuse at the time of referral to surgery.
Bradley K, Rubinsky A, Sun H, et al. Alcohol screening and risk of post-operative complications in male VA patients undergoing major non-cardiac surgery. Journal of General Internal Medicine September 28, 2010;e-pub ahead of print.
This study was funded by HSR&D (IAC 06-021). Dr. Bradley is part of VA/HSR&D’s Substance Use Disorders Quality Enhancement Research Initiative (SUD-QUERI).