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Journal of General Internal Medicine

, Volume 26, Issue 2, pp 162–169 | Cite as

Alcohol Screening and Risk of Postoperative Complications in Male VA Patients Undergoing Major Non-cardiac Surgery

  • Katharine A. BradleyEmail author
  • Anna D. Rubinsky
  • Haili Sun
  • Chris L. Bryson
  • Michael J. Bishop
  • David K. Blough
  • William G. Henderson
  • Charles Maynard
  • Mary T. Hawn
  • Hanne Tønnesen
  • Grant Hughes
  • Lauren A. Beste
  • Alex H. S. Harris
  • Eric J. Hawkins
  • Thomas K. Houston
  • Daniel R. Kivlahan
Original Research

ABSTRACT

BACKGROUND

Patients who misuse alcohol are at increased risk for surgical complications. Four weeks of preoperative abstinence decreases the risk of complications, but practical approaches for early preoperative identification of alcohol misuse are needed.

OBJECTIVE

To evaluate whether results of alcohol screening with the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) questionnaire—up to a year before surgery—were associated with the risk of postoperative complications.

DESIGN

This is a cohort study.

SETTING AND PARTICIPANTS

Male Veterans Affairs (VA) patients were eligible if they had major noncardiac surgery assessed by the VA’s Surgical Quality Improvement Program (VASQIP) in fiscal years 2004-2006, and completed the AUDIT-C alcohol screening questionnaire (0-12 points) on a mailed survey within 1 year before surgery.

MAIN OUTCOME MEASURE

One or more postoperative complication(s) within 30 days of surgery based on VASQIP nurse medical record reviews.

RESULTS

Among 9,176 eligible men, 16.3% screened positive for alcohol misuse with AUDIT-C scores ≥ 5, and 7.8% had postoperative complications. Patients with AUDIT-C scores ≥ 5 were at significantly increased risk for postoperative complications, compared to patients who drank less. In analyses adjusted for age, smoking, and days from screening to surgery, the estimated prevalence of postoperative complications increased from 5.6% (95% CI 4.8–6.6%) in patients with AUDIT-C scores 1–4, to 7.9% (6.3–9.7%) in patients with AUDIT-Cs 5–8, 9.7% (6.6–14.1%) in patients with AUDIT-Cs 9–10 and 14.0% (8.9–21.3%) in patients with AUDIT-Cs 11–12. In fully-adjusted analyses that included preoperative covariates potentially in the causal pathway between alcohol misuse and complications, the estimated prevalence of postoperative complications increased significantly from 4.8% (4.1–5.7%) in patients with AUDIT-C scores 1–4, to 6.9% (5.5–8.7%) in patients with AUDIT-Cs 5-8 and 7.5% (5.0–11.3%) among those with AUDIT-Cs 9–10.

CONCLUSIONS

AUDIT-C scores of 5 or more up to a year before surgery were associated with increased postoperative complications.

KEY WORDS

alcohol screening surgical outcomes AUDIT-C 

Notes

Acknowledgements

The authors greatly appreciate the VA Surgical Quality Data Use Group (SQDUG) and the VA Office of Quality and Performance (OQP), which shared their data with us for this project. The project would not have been possible without these data. The authors would like to further acknowledge SQDUG for its role as scientific advisors and for the critical review of data use and analysis presented in this manuscript.

Contributors

The authors would also like to thank Drs. Bevan Yueh and Emily Williams for important contributions to the design of the study and Mr. Jeff Todd-Stenberg for acquisition and merging of data.

Financial Support

The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development and Health Services Research and Development (project IAC 06-021). Dr. Bradley is an investigator at the VA Northwest HSR&D Center of Excellence and at the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA.

Prior Presentation

A portion of this work was presented at the 2009 VA Health Services Research & Development National Meeting as an oral presentation and at the 2009 VA National Leadership Board Meeting and 2009 American Society of Anesthesiologists Meeting as a poster.

Conflict of Interest

The authors certify that we have no affiliation with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the manuscript (e.g., employment, consultancies, stock ownership, honoraria).

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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Katharine A. Bradley
    • 1
    • 2
    • 3
    • 4
    Email author
  • Anna D. Rubinsky
    • 1
    • 4
  • Haili Sun
    • 1
  • Chris L. Bryson
    • 1
  • Michael J. Bishop
    • 8
    • 11
  • David K. Blough
    • 1
    • 10
  • William G. Henderson
    • 5
    • 12
  • Charles Maynard
    • 1
    • 4
  • Mary T. Hawn
    • 13
    • 16
  • Hanne Tønnesen
    • 14
  • Grant Hughes
    • 5
  • Lauren A. Beste
    • 1
    • 4
  • Alex H. S. Harris
    • 6
  • Eric J. Hawkins
    • 1
    • 2
    • 9
  • Thomas K. Houston
    • 7
    • 15
  • Daniel R. Kivlahan
    • 1
    • 2
    • 9
  1. 1.Health Services Research and DevelopmentDepartment of Veterans Affairs Puget Sound Health Care SystemSeattleUSA
  2. 2.Center of Excellence in Substance Abuse Treatment and EducationDepartment of Veterans Affairs VA Puget Sound Health Care SystemSeattleUSA
  3. 3.Department of MedicineUniversity of WashingtonSeattleUSA
  4. 4.Department of Health ServicesUniversity of WashingtonSeattleUSA
  5. 5.Department of Veterans Affairs Eastern Colorado Healthcare SystemDenverUSA
  6. 6.Center for Health Care EvaluationDepartment of Veterans Affairs Palo Alto Health Care SystemMenlo ParkUSA
  7. 7.Center for Health Quality Outcomes, and Economics ResearchBedford VAMCBedfordUSA
  8. 8.Department of Veterans Affairs Central Office Anesthesia ServiceWashingtonUSA
  9. 9.Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA
  10. 10.Department of PharmacyUniversity of WashingtonSeattleUSA
  11. 11.Department of AnesthesiologyUniversity of WashingtonSeattleUSA
  12. 12.University of Colorado Health Outcomes ProgramAuroraUSA
  13. 13.Department of SurgeryUniversity of Alabama at BirminghamBirminghamUSA
  14. 14.WHO Collaborating Centre for Evidence-Based Health Promotion in Hospitals & Health ServicesBispebjerg University HospitalCopenhagenDenmark
  15. 15.Department of Quantitative Health Sciences, Division of Health Informatics and Implementation ScienceUniversity of Massachusetts Medical SchoolWorcesterUSA
  16. 16.Center for Surgical, Medical, Acute care Research and Transitions (C-SMART)Birmingham Veterans Affairs Medical CenterBirminghamUSA

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