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Tuesday, May 28, 2013

Postoperative risks associated with alcohol screening depend on documented drinking at the time of surgery



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 >2 d/d”) are associated with increased postoperative complications and health care utilization. The purpose of this study was to evaluate whether documented drinking >2 d/d contributed additional information about postoperative risk beyond past-year AUDIT-C screening results.

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 >2 d/d, with AUDIT-C scores 1–4 and no documented drinking >2 d/d as the referent, after adjusting for important covariates.

Overall 8811 patients met inclusion criteria. Among patients with documented drinking >2 d/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 >2 d/d, increasing AUDIT-C scores were not associated with these outcomes.
Clinical documentation of drinking >2 d/d immediately prior to surgery contributed additional information about postoperative risk beyond past-year AUDIT-C score. However, among patients with documented drinking >2 d/d, postoperative risk varied widely depending on the AUDIT-C score.

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