Preop Alcohol Screening May Predict Postop Complications

Jenni Laidman

March 16, 2012

March 16, 2012 — A brief survey of drinking habits administered as long as a year before surgery might help identify patients at risk for longer hospital stays, more time in intensive care, and an increased need for a second surgery, according to results of a study published online January 12 and in the March print issue of the Journal of the American College of Surgeons.

Anna D. Rubinsky, MS, Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, and colleagues measured hospital length of stay, days in intensive care, need for a second surgery, and hospital readmission among 5171 men in the Veterans Affairs health system who underwent nonemergency, noncardiac major surgery within a year of taking the 12-point Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire.

As in several earlier studies, researchers found that heavy drinkers (those who scored 9 - 12 on the AUDIT-C measure) were at increased postoperative risk. In this study, compared with light drinkers (an AUDIT-C score of 1 - 4), heavy drinkers stayed in the hospital almost a day longer after surgery, stayed in the intensive care unit (ICU) 1.5 times longer, and were twice as likely to need to return to the operating room (OR) within 30 days of surgery.

"The findings from this study indicate that preoperative alcohol screening might serve as an effective tool to identify patients at risk for increased postoperative care," Rubinsky said in a press release. "Implementing preoperative alcohol screening and providing proactive interventions could potentially decrease the need for costly postoperative resources and improve patient outcomes."

After adjusting for sociodemographic factors, smoking status, surgical current procedural terminology, surgical relative value unit, and days between the AUDIT-C and surgery, high-risk drinkers were in the hospital 5.8 days (95% confidence interval [CI], 5.0 - 6.7 days; P < .05) compared with the comparison group of low-risk drinkers, whose adjusted stay was 5.0 days (95% CI, 4.7 - 5.3 days).

Among the 1913 patients who required intensive care, ICU stays were more than 1.5 times longer among the high-risk drinkers (mean, 4.5 days; 95% CI, 3.2 - 5.8 days; P < .05) than among the low-risk drinkers (mean, 2.8 days; 95% CI, 2.6 - 3.1 days) in adjusted analysis.

In addition, high-risk drinkers were twice as likely to require a return to the OR (10%; 95% CI, 6% - 13%; P < .01) than low-risk drinkers (5%; 95% CI, 4% - 6%) in adjusted calculations.

However, high-risk drinkers were not more likely to be readmitted to the hospital in the 30 days after surgery. The adjusted predicted probability for readmission among heavy drinkers was 0.07 (95% CI, 0.04 - 0.11) compared with 0.06 (95% CI, 0.05 - 0.07) among low-risk drinkers.

Low-risk drinkers were used as the baseline measure because nondrinkers have been previously found to have more comorbidity and more frequent postoperative complications. The same proved true in this study, with the 2439 nondrinkers enduring longer hospital stays (mean, 5.4 days; 95% CI, 5.1 - 5.7 days; P < .05) compared with low-risk drinkers (mean, 5.0 days; 95% CI, 4.7 - 5.3). They also spent more time in the ICU (3.2 days; 95% CI, 2.9 - 3.6 days; P < .05) compared with low-risk drinkers (2.8 days; 95% CI, 2.6 - 3.1 days). Nondrinkers also were slightly more likely to need additional surgery (6%; 95% CI, 5% - 7%; P < .05) compared with low-risk drinkers (5%; 95% CI, 4% - 6%).

Nondrinkers also showed a higher level of hospital readmission than low-risk drinkers, at 8% (95% CI, 7% - 9%; P < .05) vs 6% (95% CI, 5% - 7%).

The fourth group in the study, at-risk drinkers, who scored 5 to 8 on AUDIT-C, were found to be at no greater risk for increased postoperative complications than low-risk drinkers.

The 230 men in the high-risk group were younger, with an average age of 60 years (±7 years), compared with the 1853 men in the low-risk group (aged 65 ± 11 years). They were also less likely to be married (40% vs 56%), more likely to be past-year smokers (61% vs 29%), and less likely to be disabled, with 15% of high-risk drinkers more than 50% disabled compared with 19% of the low-risk drinkers.

Women were excluded from the study because of their low numbers. Of the 280 women eligible, only 14 (5%) were in the high-risk group.

The authors have disclosed no relevant financial relationships.

J Am Coll Surg. 2012:214:296-305.e1. Abstract

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