Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery.
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.


METHODS
This is a cohort study.


METHODS
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.


METHODS
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.
Bradley
Katharine A
KA
Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA 98101, USA. willi@u.washington.edu
Rubinsky
Anna D
AD
Sun
Haili
H
Bryson
Chris L
CL
Bishop
Michael J
MJ
Blough
David K
DK
Henderson
William G
WG
Maynard
Charles
C
Hawn
Mary T
MT
Tønnesen
Hanne
H
Hughes
Grant
G
Beste
Lauren A
LA
Harris
Alex H S
AH
Hawkins
Eric J
EJ
Houston
Thomas K
TK
Kivlahan
Daniel R
DR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications* / Q000453:epidemiology*; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D011300:Preoperative Care / Q000379:methods; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans; D055815:Young Adult