Adverse Surgical Outcomes Linked to Co-occurring Smoking and Risky Alcohol Use Among General Surgery Patients

Abstract

Objective: To assess associations between co-occurring preoperative smoking and risky alcohol use on the likelihood of adverse surgical outcomes. Background: Risky alcohol use and smoking are the known surgical risk factors with a high co-occurrence and additive adverse effects on multiple organ systems that impact surgical health, yet no research has evaluated the impact of co-occurrence on surgical outcomes. Methods: This investigation analyzed 200,816 patients from the Michigan Surgical Quality Collaborative database between July 1, 2012, to December 31, 2018. Patients were classified based on past year risky alcohol use (>2 drink/day) and cigarette smoking into 4 groups: (1) risky alcohol and smoking, (2) risky alcohol only, (3) smoking only, and (4) no risky alcohol/smoking. We fitted logistic regression models, applying propensity score weights incorporating demographic, clinical, and surgical factors to assess associations between alcohol and smoking and 30-day postoperative outcomes; surgical complications, readmission, reoperation, and emergency department (ED) visits. Results: Risky alcohol and smoking, risky alcohol only, and smoking only were reported by 2852 (1.4%), 2840 (1.4%), and 44,042 (22%) patients, respectively. Relative to all other groups, the alcohol and smoking group had greater odds of surgical complications, readmission, and reoperation. Relative to the no alcohol and smoking group, the alcohol only group higher odds of reoperation and smoking only group had higher odds of emergency department visits. Conclusions: The combination of smoking and risky drinking conferred the highest likelihood of complications, readmission, and reoperation before surgery. Co-occurring alcohol and smoking at the time of surgery warrants special attention as a patient risk factor and deserves additional research.

Automated‐detection of risky alcohol use prior to surgery using natural language processing

“…This total prevalence of risky alcohol use identified using NLP (14.5%) aligns more with the expected prevalence of risky alcohol use and alcohol use disorders in the population and provides further support for the accuracy of NLP (Grant et al., 2017). The low rate of identification of alcohol problems using ICD codes alone is consistent with other studies in the literature (Fernandez et al., 2023; Fernandez, Bohnert, et al., 2022; Grant et al., 2017).…”

“…Studies on alcohol use among surgery patients that use EHR data, vastly under‐identify patients drinking at risky levels for surgery. For example, one recent study found only 2.8% of elective surgery patients were classified with risky drinking (>2 drinks/day) based on EHR review, suggesting automated chart review methods, such as the one presented herein, could improve patient identification (Fernandez, Bohnert, et al., 2022).…”

Transforming the Future of Surgeon-Scientists

“…Many for-profit entities, such as pharmaceutical companies, device companies, and the health insurance industry, greatly benefit from the work and the discovery of surgeon scientists. 19,20 Partnerships with these organizations can help bridge the funding gap and support innovative quality research or novel device and drug development. Institutions and departments should consider these potential partnerships and potentially build a revenue stream that could be directed toward funding relevant research efforts of young investigators.…”

“…Many for-profit entities, such as pharmaceutical companies, device companies, and the health insurance industry, greatly benefit from the work and the discovery of surgeon scientists 19,20 . Partnerships with these organizations can help bridge the funding gap and support innovative quality research or novel device and drug development.…”

Physical Activity, Alcohol, and Cigarette Use in Urological Cancer Patients over Time since Diagnosis

“…Nonetheless, there exists compelling evidence that both alcohol usage and risky drinking behaviors are prevalent among individuals who have successfully recovered from cancer and those undergoing treatment [ 8 ]. It is crucial to emphasize that alcohol consumption is linked to heightened postoperative risks [ 9 , 10 ] and exacerbates the efficacy of cancer therapy [ 8 ]. These factors potentially carry implications for the outcomes of surgical interventions in patients afflicted with urological cancers.…”