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

Bradley, Katharine A.; Rubinsky, Anna D.; Sun, Haili; Bryson, Chris L.; Bishop, Michael J.; Blough, David K.; Henderson, William G.; Maynard, Charles; Hawn, Mary T.; Tønnesen, Hanne; Hughes, Grant; Beste, Lauren A.; Harris, Alex H. S.; Hawkins, Eric J.; Houston, Thomas K.; Kivlahan, Daniel R.

doi:10.1007/s11606-010-1475-x

Cited by 109 publications

(81 citation statements)

References 46 publications

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“…Further, while the present study had too few women to enable stratified analyses, future research should be stratified by gender when possible. The VASQIP database does not comprehensively capture patient factors, such as other substance use, mental health diagnoses, and socioeconomic determinants, which are known to be associated with unhealthy alcohol use and may also influence post-operative complications (18,43). Similarly, laboratory measures that may be associated with alcohol use and surgical complications, such as tests of liver function and coagulopathy, are not consistently available in VASQIP.…”

Section: Discussionmentioning

confidence: 99%

“…Unhealthy alcohol usethe spectrum from drinking above national recommended limits to meeting diagnostic criteria for alcohol use disorders (17)-is known to be associated with complications of various surgical procedures (18)(19)(20)(21)(22). Further, it is possible that reduction of alcohol use in the perioperative period may mitigate risk (23,24).…”

Section: Introductionmentioning

confidence: 99%

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Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection

Graf¹,

Zeliadt²,

Rise³

et al. 2018

J. Thorac. Dis.

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Background: Lung resections carry a significant risk of complications necessitating the characterization of peri-operative risk factors. Unhealthy alcohol use represents one potentially modifiable factor. In this retrospective cohort study, the largest to date of lung resections in the Veterans Health Administration (VHA), we examined the association between unhealthy alcohol use and postoperative complications and mortality. Methods: Veterans Affairs Surgical Quality Improvement Program data recorded at 86 medical centers between 2007 and 2011 were used to identify 4,715 patients that underwent lung resection. Logistic regression models, adjusted for demographics and comorbidities, were fit to assess the association between unhealthy alcohol use (report of >2 drinks per day in the 2 weeks preceding surgery) and 30-day outcomes. Results: Among 4,715 patients that underwent pulmonary resection, 630 (13.4%) reported unhealthy alcohol use (>2 drinks/day). Overall, postoperative complications occurred in 896 (19.0%) patients, including pneumonia in 524 (11.1%). The rate of mortality was 2.6%. In adjusted analyses, complications were significantly more common among patients with unhealthy alcohol use [odds ratio (OR), 1.42; 95% confidence interval (CI), 1.15-1.74] including, specifically, pneumonia (OR, 1.69; 95% CI, 1.32-2.15). No statistically significant association was identified between unhealthy alcohol use and mortality (OR, 1.27; 95% CI, 0.75-2.02). In secondary analyses that stratified by smoking status at the time of surgery, drinking more than 2 drinks per day was associated with post-operative complications in patients reporting current smoking (OR, 1.51; 95% CI, 1.18-1.91) and was not identified in those reporting no current smoking at the time of surgery (OR, 1.23; 95% CI, 0.79-1.85). Conclusions:In this large VHA study, 13% of patients undergoing lung resection reported drinking more than 2 drinks per day in the preoperative period, which was associated with increased risk of postoperative complications. Unhealthy alcohol use may be an important target for perioperative risk-mitigation interventions, particularly in patients who report current smoking.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection

Graf¹,

Zeliadt²,

Rise³

et al. 2018

J. Thorac. Dis.

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“…Več tujih raziskav je pokazalo, da zdravstvenovzgojni programi med hospitalizacijo pozitivno vplivajo na zmanjšanje simptomov, krajši čas hospitalizacije in splošno dobro počutje pri pacientih s kroničnimi obolenji (Thomsen, et al, 2009;Bradley, et al, 2011;Prorok, et al, 2015). Pacienti, ki so prejeli razumljive zdravstvenovzgojne nasvete, so pogosteje imeli občutek aktivne vključenosti v zdravljenje (Farkaš-Lainščak, 2011;Brady, et al, 2013).…”

Section: Uvodunclassified

Dokumentiranje navodil o življenjskem slogu in samoobvladovanju bolezni pri pacientih s kronično obstruktivno pljučno boleznijo

2018

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IZVLEČEKUvod: Za boljše doseganje kakovosti življenja pacientov s kronično obstruktivno pljučno boleznijo je slednje treba poučiti o značilnostih bolezni ter o ukrepih za njeno učinkovito samoobvladovanje. Namen raziskave je bil ugotoviti pogostost dokumentiranja in vrsto dokumentiranih navodil o življenjskem slogu in samoobvladovanju bolezni v bolnišnični dokumentaciji pacientov s kronično obstruktivno pljučno boleznijo. Metode: Izvedena je bila retrospektivna kvantitativna raziskava, v kateri je bila pregledana celotna bolnišnična dokumentacija (terapevtski listi, liste zdravstvene nege, arhivi zdravstvenovzgojnih šol, odpustna pisma) 253 pacientov s kronično obstruktivno pljučno boleznijo. Za analizo podatkov sta bila poleg osnovne deskriptivne statistike uporabljena tudi hi-kvadrat test in ordinalna logistična regresija. Rezultati: V bolnišnični dokumentaciji so pacienti s kronično obstruktivno pljučno boleznijo imeli dokumentirana v povprečju manj kot 4 navodila o življenjskem slogu in samoobvladovanju bolezni ( = 3,8, s = 5,1). V odpustnem pismu je polovica pacientov ( = 0,5, s = 0,9) imela zabeleženih manj navodil o življenjskem slogu in samoobvladovanju bolezni kot v bolnišnični dokumentaciji (x 2 = 33,455, p < 0,001). Diplomirane medicinske sestre so navodila dokumentirale petkrat pogosteje kot zdravniki. Diskusija in zaključek: Raziskava je za bolnišnično dokumentacijo pacientov s kronično obstruktivno pljučno boleznijo ugotovila nizko število dokumentiranih navodil o življenjskem slogu in samoobvladovanju bolezni. Treba bo povečati ozaveščenost o pomenu dokumentiranja zdravstvenovzgojnih navodil in oblikovati orodja za izboljšanje medpoklicne komunikacije. ABSTRACTIntroduction: To achieve a better quality of life in patients with chronic obstructive pulmonary disease, these patients should be informed about the characteristics of the disease and measures for its effective selfmanagement. The aim of the study was to determine the frequency and type of written instructions regarding lifestyle and self-management of the disease in hospital documentation of patients with chronic obstructive pulmonary disease. Methods: A retrospective quantitative study that reviewed all the hospital's documents (therapy forms, nursing forms, archives of health education programmes, letters of discharge) was conducted including 253 patients with chronic obstructive pulmonary disease. The results were described in terms of descriptive statistics; chisquare test and ordinal logistic regression were used. Results: On average, hospital records of patients with chronic obstructive pulmonary disease showed less than 4 instructions ( = 3.8, s = 5.1) about life style and disease self-management. Half of chronic obstructive pulmonary disease patients received letters of discharge ( = 0.5, s = 0.9) which contained less guidance about lifestyle and self-management of the disease than their hospital records (x 2 = 33.455, p < 0.001). Nurses recorded the instructions five times more frequently than doctors. Discussion and conclusion: T...

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“…[30] A study of over 9,000 Veterans Administration surgeries found that complication rates increased from 5.6% to 14.0% in a dose-response manner with higher self-reports of alcohol use. [31] …”

Section: Readmissionsmentioning

confidence: 99%

The business case for hospital-based Behavioral Screening and Intervention

Brown¹

2015

JHA

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Under the Affordable Care Act, hospitals are challenged to avoid growing penalties for adverse outcomes, including readmissions, and to adapt to value-based purchasing, where parent organizations will ultimately regard hospital revenues as costs. Hospitals are responding by implementing quality improvement programs, strengthening coordination of care around and after discharge, and enhancing chronic disease management, but many hospitals continue to suffer penalties. An additional response could be to systematically conduct screening and intervention for "upstream" behavioral risks and disorders -smoking, unhealthy drinking and depression -which are associated with admissions, inferior medical and surgical outcomes, readmissions, and ample costs. By increasing smoking quit rates, reducing binge drinking and enhancing depression outcomes, Behavioral Screening and Intervention (BSI) could improve outcomes for various chronic diseases, prevent acute disease and injury, decrease hospital admissions and readmissions, avert surgical complications, and improve hospitals' bottom lines. This article discusses how hospitals could implement BSI and potential benefits, barriers and limitations.

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

Abstract: AUDIT-C scores of 5 or more up to a year before surgery were associated with increased postoperative complications.

Cited by 109 publications

References 46 publications

Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection

Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection

Dokumentiranje navodil o življenjskem slogu in samoobvladovanju bolezni pri pacientih s kronično obstruktivno pljučno boleznijo

The business case for hospital-based Behavioral Screening and Intervention

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