Alcohol Screening and Risk of Postoperative Complications in Male VA Patients Undergoing Major Non-cardiac Surgery
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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.
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.
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.
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.
AUDIT-C scores of 5 or more up to a year before surgery were associated with increased postoperative complications.
KEY WORDSalcohol screening surgical outcomes AUDIT-C
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.
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.
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.
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).
- 17.Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–1795.CrossRefPubMedGoogle Scholar
- 25.National Institute on Alcohol Abuse and Alcoholism, US Department of Health and Human Services, National Institute of Health. Helping Patients Who Drink Too Much: A Clinician’s Guide (updated 2005 guide). Rockville, MD; 2007.Google Scholar
- 41.Stata Statistical Software: Release Special Edition 10.1 [computer program]. College Station TX: Stata Corporation; 2007.Google Scholar