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

Bradley, KA; Rubinsky, AD; Sun, H; Bryson, CL; Bishop, MK; Blough, DK; Henderson, WG; Maynard, C; Hawn, MT and Tønnesen, Hanne LU , et al. (2011) In Journal of General Internal Medicine 26(2). p.162-169
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... (More)
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. (Less)
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published
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in
Journal of General Internal Medicine
volume
26
issue
2
pages
162 - 169
publisher
Springer New York
external identifiers
  • pmid:20878363
  • scopus:78751591072
ISSN
0884-8734
DOI
10.1007/s11606-010-1475-x
language
English
LU publication?
yes
id
9e17ab1a-0491-4758-9245-dd912477c944 (old id 2364183)
date added to LUP
2012-05-04 10:50:01
date last changed
2017-07-23 04:59:08
@article{9e17ab1a-0491-4758-9245-dd912477c944,
  abstract     = {BACKGROUND:<br/><br>
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.<br/><br>
<br/><br>
OBJECTIVE:<br/><br>
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.<br/><br>
<br/><br>
DESIGN:<br/><br>
This is a cohort study.<br/><br>
<br/><br>
SETTING AND PARTICIPANTS:<br/><br>
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.<br/><br>
<br/><br>
MAIN OUTCOME MEASURE:<br/><br>
One or more postoperative complication(s) within 30 days of surgery based on VASQIP nurse medical record reviews.<br/><br>
RESULTS<br/><br>
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.<br/><br>
<br/><br>
CONCLUSIONS:<br/><br>
AUDIT-C scores of 5 or more up to a year before surgery were associated with increased postoperative complications.},
  author       = {Bradley, KA and Rubinsky, AD and Sun, H and Bryson, CL and Bishop, MK and Blough, DK and Henderson, WG and Maynard, C and Hawn, MT and Tønnesen, Hanne and Hughes, Grant and Beste, LA and Harris, AH and Hawkins, EJ and Houston, TK and Kivlahan, DR},
  issn         = {0884-8734},
  language     = {eng},
  number       = {2},
  pages        = {162--169},
  publisher    = {Springer New York},
  series       = {Journal of General Internal Medicine},
  title        = {Alcohol Screening and Risk of Postoperative Complications on Male VA Patients Undergoing Major Non-cardiac Surgery},
  url          = {http://dx.doi.org/10.1007/s11606-010-1475-x},
  volume       = {26},
  year         = {2011},
}