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

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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 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.

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Acknowledgements

The authors greatly appreciate the VA Surgical Quality Data Use Group (SQDUG) and the VA Office of Quality and Performance (OQP), which shared their data with us for this project. The project would not have been possible without these data. The authors would like to further acknowledge SQDUG for its role as scientific advisors and for the critical review of data use and analysis presented in this manuscript.

Contributors

The authors would also like to thank Drs. Bevan Yueh and Emily Williams for important contributions to the design of the study and Mr. Jeff Todd-Stenberg for acquisition and merging of data.

Financial Support

The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development and Health Services Research and Development (project IAC 06-021). Dr. Bradley is an investigator at the VA Northwest HSR&D Center of Excellence and at the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA.

Prior Presentation

A portion of this work was presented at the 2009 VA Health Services Research & Development National Meeting as an oral presentation and at the 2009 VA National Leadership Board Meeting and 2009 American Society of Anesthesiologists Meeting as a poster.

Conflict of Interest

The authors certify that we have no affiliation with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the manuscript (e.g., employment, consultancies, stock ownership, honoraria).

Author information

Authors and Affiliations

  1. Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA, 98101, USA

    Katharine A. Bradley MD, MPH, Anna D. Rubinsky MS, Haili Sun PhD, Chris L. Bryson MD, MS, David K. Blough PhD, Charles Maynard PhD, Lauren A. Beste MD, MS, Eric J. Hawkins PhD & Daniel R. Kivlahan PhD

  2. Center of Excellence in Substance Abuse Treatment and Education, Department of Veterans Affairs VA Puget Sound Health Care System, Seattle, WA, USA

    Katharine A. Bradley MD, MPH, Eric J. Hawkins PhD & Daniel R. Kivlahan PhD

  3. Department of Medicine, University of Washington, Seattle, WA, USA

    Katharine A. Bradley MD, MPH

  4. Department of Health Services, University of Washington, Seattle, WA, USA

    Katharine A. Bradley MD, MPH, Anna D. Rubinsky MS, Charles Maynard PhD & Lauren A. Beste MD, MS

  5. Department of Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, USA

    William G. Henderson PhD, MPH & Grant Hughes BS

  6. Center for Health Care Evaluation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA

    Alex H. S. Harris PhD, MS

  7. Center for Health Quality Outcomes, and Economics Research, Bedford VAMC, Bedford, TX, USA

    Thomas K. Houston MD, MPH

  8. Department of Veterans Affairs Central Office Anesthesia Service, Washington, DC, USA

    Michael J. Bishop MD

  9. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA

    Eric J. Hawkins PhD & Daniel R. Kivlahan PhD

  10. Department of Pharmacy, University of Washington, Seattle, WA, USA

    David K. Blough PhD

  11. Department of Anesthesiology, University of Washington, Seattle, WA, USA

    Michael J. Bishop MD

  12. University of Colorado Health Outcomes Program, Aurora, CO, USA

    William G. Henderson PhD, MPH

  13. Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Mary T. Hawn MD, MPH

  14. WHO Collaborating Centre for Evidence-Based Health Promotion in Hospitals & Health Services, Bispebjerg University Hospital, Copenhagen, Denmark

    Hanne Tønnesen MD, DMSc

  15. Department of Quantitative Health Sciences, Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA

    Thomas K. Houston MD, MPH

  16. Center for Surgical, Medical, Acute care Research and Transitions (C-SMART), Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

    Mary T. Hawn MD, MPH

Authors
  1. Katharine A. Bradley MD, MPH
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  2. Anna D. Rubinsky MS
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  3. Haili Sun PhD
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  4. Chris L. Bryson MD, MS
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  5. Michael J. Bishop MD
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  6. David K. Blough PhD
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  7. William G. Henderson PhD, MPH
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  8. Charles Maynard PhD
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  9. Mary T. Hawn MD, MPH
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  10. Hanne Tønnesen MD, DMSc
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  11. Grant Hughes BS
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  12. Lauren A. Beste MD, MS
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  13. Alex H. S. Harris PhD, MS
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  14. Eric J. Hawkins PhD
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  15. Thomas K. Houston MD, MPH
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  16. Daniel R. Kivlahan PhD
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Corresponding author

Correspondence to Katharine A. Bradley MD, MPH.

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Bradley, K.A., Rubinsky, A.D., Sun, H. et al. Alcohol Screening and Risk of Postoperative Complications in Male VA Patients Undergoing Major Non-cardiac Surgery. J GEN INTERN MED 26, 162–169 (2011). https://doi.org/10.1007/s11606-010-1475-x

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  • DOI: https://doi.org/10.1007/s11606-010-1475-x

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