title: Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery.
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.
  
  
  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.
authors.affiliation: Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA 98101, USA. willi@u.washington.edu
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
authors.forename: Anna D
authors.initials: AD
authors.lastname: Rubinsky
authors.forename: Haili
authors.initials: H
authors.lastname: Sun
authors.forename: Chris L
authors.initials: CL
authors.lastname: Bryson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bishop
authors.forename: David K
authors.initials: DK
authors.lastname: Blough
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
authors.forename: Hanne
authors.initials: H
authors.lastname: Tønnesen
authors.forename: Grant
authors.initials: G
authors.lastname: Hughes
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beste
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Hawkins
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Houston
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
mesh_terms: 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