A systematic review of behavioural interventions to reduce preoperative alcohol use

Abstract

Issues Preoperative alcohol use is associated with an increase in postoperative morbidity and mortality. Short-term abstinence prior to elective surgery has been shown to reduce postoperative risks. Therefore, behavioural intervention (BI) targeting risky drinking may have significant utility in preventing surgical complications. Approach The literature was systematically reviewed to identify the scope and outcomes of BIs aiming to reduce alcohol use in risky drinkers before they underwent surgery. Five databases were searched using PRISMA criteria. Of 1243 studies identified, four met pre-established inclusion criteria: (i) implementation of a BI prior to an elective surgery; (ii) the BI-targeted alcohol use among risky drinkers; and (iii) printed in English. Key Findings Two studies indicated significant reductions in alcohol use at follow ups, and one study demonstrated reductions in postoperative risks. These findings are encouraging, but in light of methodological limitations, the efficacy of preoperative BIs for risky drinking could not be determined. Implications Future efforts to screen and implement BIs addressing alcohol use in preoperative patients should carefully define risky drinking, allow ample time for recruitment prior to surgery, implement empirically supported interventions, examine the impact of relevant covariates, and consider the statistical power needed to detect change in postoperative complications. Conclusion Given the strong link between preoperative alcohol use and postoperative risks, additional research on preoperative BIs is critically needed. Existing research suggests several promising directions for research that may enhance future intervention efforts with this high-risk population.

Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT

“…Patients in the intervention group showed greater rates of smoking cessation, physical activity and weight loss than the control group and greater improvements in blood pressure. Alcohol consumption outcome data were not published in this original study report but were included in a subsequent review, 99 which identified a significant group × time interaction whereby the intervention group decreased their weekly alcohol consumption by 1.2 standard drinks per week between baseline and follow-up, whereas the control group showed an average increase of 1.3 drinks per week over the same period. With an average of > 8 months from trial entry to surgery date, patients had adequate time to implement behaviour change and observe positive health outcomes.…”

“…A further trial considered preoperative alcohol consumption as part of a multimodal 'prehabilitation' package and planned to provide interventions for risky drinking but did not identify any patients drinking at risky levels. 102 The four studies assessing behavioural interventions for alcohol consumption in the preoperative period have been drawn together in a narrative review conducted by Fernandez et al 99 This review identified some positive findings, with two of the trials identifying significant reductions in alcohol consumption and one identifying a significant reduction in postoperative complications. However, it also highlighted a number of methodological weaknesses of the current evidence and made multiple recommendations for future research.…”

“…103 This suggests a number of possibilities: alcohol consumption levels may be much lower in certain surgical populations, those drinking at risky levels may be less likely to participate in intervention trials or alcohol consumption may be under-reported by trial participants. Fernandez et al 99 recommend adopting clear, precise definitions of risky drinking and using unbiased screening to detect those drinking at risky levels.…”

“…Further recommendations resulting from this review 99 include assessing change in alcohol use preoperatively as well as postoperatively to allow the assessment of preoperative change on postoperative outcomes; a focus on the needs of older adults because the average age of trial participants is < 50 years; using empirically supported interventions and improving the reporting of both intervention content and fidelity of delivery; delivering interventions early enough in the preoperative care pathway to allow adequate time for behaviour change and subsequent pathophysiological improvement; and careful consideration of the sample size required to ensure adequately powered evaluations.…”

“…Introduction When considering behavioural interventions to target alcohol consumption in the preoperative setting, a key limitation of the literature is the lack of information on intervention content. 99 This prevents intervention replication 117 and further exploration of what makes an intervention effective. Furthermore, fidelity of intervention delivery has not been assessed in the trials reporting on behavioural interventions in the preoperative period.…”