title: Postoperative risks associated with alcohol screening depend on documented drinking at the time of surgery.
abstract: BACKGROUND
  Both AUDIT-C alcohol screening scores up to a year before surgery and clinical documentation of drinking over 2 drinks per day immediately prior to surgery ("documented drinking >2d/d") are associated with increased postoperative complications and health care utilization. The purpose of this study was to evaluate whether documented drinking >2d/d contributed additional information about postoperative risk beyond past-year AUDIT-C screening results.
  
  
  METHODS
  Male Veterans Affairs (VA) patients who had a non-emergent, non-cardiac, major surgery assessed by the VA's Surgical Quality Improvement Program 10/2003-9/2006 and completed the AUDIT-C by mailed survey in the prior year were eligible for this study. Linear or logistic regression models compared 30-day postoperative complication(s), return to operating room (OR), hospital length of stay (LOS), and intensive care unit (ICU) days across eight groups defined by past-year AUDIT-C score and clinically documented drinking >2d/d, with AUDIT-C scores 1-4 and no documented drinking >2d/d as the referent, after adjusting for important covariates.
  
  
  RESULTS
  Overall 8811 patients met inclusion criteria. Among patients with documented drinking >2d/d immediately prior to surgery, postoperative risk varied widely depending on past-year AUDIT-C score; scores ≥5 were associated with increased risk of complication(s), and scores ≥9 with increased hospital LOS and ICU days. Among patients without documentation of drinking >2d/d, increasing AUDIT-C scores were not associated with these outcomes.
  
  
  CONCLUSIONS
  Clinical documentation of drinking >2d/d immediately prior to surgery contributed additional information about postoperative risk beyond past-year AUDIT-C score. However, among patients with documented drinking >2d/d, postoperative risk varied widely depending on the AUDIT-C score.
authors.affiliation: Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; Department of Health Services, University of Washington, Seattle, WA, United States. Electronic address: Anna.Rubinsky@va.gov.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Rubinsky
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bishop
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beste
authors.forename: Hanne
authors.initials: H
authors.lastname: Tønnesen
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology*; D000437:Alcoholism / Q000453:epidemiology; D006306:Health Surveys / Q000379:methods; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D013997:Time Factors; D014728:Veterans
keywords: AUDIT-C; Alcohol; Drinking; Postoperative complications; Postoperative health care utilization