Alcohol Misuse Prevalence and Associations with Post-Operative Complications in US Surgical Patients: A Review

Harris, Alex H. S.; Frey, Madeleine S.; DeBenedetti, Anna F.; Bradley, Katharine A.

doi:10.2174/1874300500802010050

Cited by 12 publications

(11 citation statements)

References 64 publications

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“…Each year 14% of Americans meet criteria for an alcohol use disorder and 13% smoke cigarettes 1,2 . In surgical populations, the prevalence of these behaviors is higher, with as many as 1 in 4 surgical patients smoking and/or drinking alcohol at risky levels 3,4 . In fact, smoking and risky alcohol use (defined as consuming >2 drinks per day) before surgery are 2 of the most common risk factors for poor outcomes after surgery 5 .…”

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confidence: 99%

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

et al. 2022

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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.

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confidence: 99%

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

et al. 2022

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“…head and neck tumour surgeries). 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.…”

Section: Behavioural Interventions In the Preoperative Periodmentioning

confidence: 99%

“…Qualitative evidence 92 has identified time and burden of new processes as key barriers to the implementation of alcohol screening and BI, and findings from alcohol screening studies conducted in PA have reported that the majority of patients drink at 'safe' or 'sensible' drinking levels. 62,103 Therefore, it is appropriate to use a short initial screen (AUDIT-C) to identify potentially eligible patients, with the longer full AUDIT being used to inform intervention delivery and, potentially, the tailoring of intervention content.…”

Section: Screening Tool Selectionmentioning

confidence: 99%

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

Snowden

Lynch

Avery

et al. 2020

Health Technol Assess

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Background Heavy alcohol consumption is associated with an increased risk of postoperative complications and extended hospital stay. Alcohol consumption therefore represents a modifiable risk factor for surgical outcomes. Brief behavioural interventions have been shown to be effective in reducing alcohol consumption among increased risk and risky drinkers in other health-care settings and may offer a method of addressing preoperative alcohol consumption. Objectives To investigate the feasibility of introducing a screening process to assess adult preoperative drinking levels and to deliver a brief behavioural intervention adapted for the target population group. To conduct a two-arm (brief behavioural intervention plus standard preoperative care vs. standard preoperative care alone), multicentre, pilot randomised controlled trial to assess the feasibility of proceeding to a definitive trial. To conduct focus groups and a national web-based survey to establish current treatment as usual for alcohol screening and intervention in preoperative assessment. Design A single-centre, qualitative, feasibility study was followed by a multicentre, two-arm (brief behavioural intervention vs. treatment as usual), individually randomised controlled pilot trial with an embedded qualitative process evaluation. Focus groups and a quantitative survey were employed to characterise treatment as usual in preoperative assessment. Setting The feasibility study took place at a secondary care hospital in the north-east of England. The pilot trial was conducted at three large secondary care centres in the north-east of England. Participants Nine health-care professionals and 15 patients (mean age 70.5 years, 86.7% male) participated in the feasibility study. Eleven health-care professionals and 68 patients (mean age 66.2 years, 80.9% male) participated in the pilot randomised trial. An additional 19 health-care professionals were recruited to one of three focus groups, while 62 completed an electronic survey to characterise treatment as usual. Interventions The brief behavioural intervention comprised two sessions. The first session, delivered face to face in the preoperative assessment clinic, involved 5 minutes of structured brief advice followed by 15–20 minutes of behaviour change counselling, including goal-setting, problem-solving and identifying sources of social support. The second session, an optional booster, took place approximately 1 week before surgery and offered the opportunity to assess progress and boost self-efficacy. Main outcome measures Feasibility was assessed using rates of eligibility, recruitment and retention. The progression criteria for a definitive trial were recruitment of ≥ 40% of eligible patients and retention of ≥ 70% at 6-month follow-up. Acceptability was assessed using themes identified in qualitative data. Results The initial recruitment of eligible patients was low but improved with the optimisation of recruitment processes. The recruitment of eligible participants to the pilot trial (34%) fell short of the progression criteria but was mitigated by very high retention (96%) at the 6-month follow-up. Multimethod analyses identified the methods as acceptable to the patients and professionals involved and offers recommendations of ways to further improve recruitment. Conclusions The evidence supports the feasibility of a definitive trial to assess the effectiveness of brief behavioural intervention in reducing preoperative alcohol consumption and for secondary outcomes of surgical complications if recommendations for further improvements are adopted. Trial registration Current Controlled Trials ISRCTN36257982. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 12. See the National Institute for Health Research Journals Library website for further project information.

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“…A growing body of research indicates that risky drinking prior to surgery can have a detrimental impact on postoperative recovery [19,[21][22][23][24][25][26][27]. Rates of risky alcohol use prior to elective surgeries range from 30.0% to 88.5% among otolaryngology surgeries, from 29% to 33% among vascular and thoracic surgeries and from 7.7% to 28.0% among other types of surgery [28]. The research linking risky drinking and postoperative problems is robust.…”

Section: Alcohol Use and Postoperative Morbidity And Mortalitymentioning

confidence: 99%

A systematic review of behavioural interventions to reduce preoperative alcohol use

Fernandez

Claborn

Borsari

2015

Drug and Alcohol Review

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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.

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Alcohol Misuse Prevalence and Associations with Post-Operative Complications in US Surgical Patients: A Review

Cited by 12 publications

References 64 publications

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

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

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

A systematic review of behavioural interventions to reduce preoperative alcohol use

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