Preoperative alcohol interventions for elective surgical patients: Results from a randomized pilot trial

Fernandez, Anne C.; Chapman, Lyndsay; Ren, Tom Y.; Baxley, Catherine; Hallway, Alexander; Tang, Michael J.; Waljee, Jennifer F.; Friedmann, Peter D.; Mello, Michael J.; Borsari, Brian; Blow, Frederic C.

doi:10.1016/j.surg.2022.09.012

Cited by 6 publications

(4 citation statements)

References 36 publications

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“…This problem has been shown in a large cohort study on major surgery, which reported that the routinely obtained alcohol history close to the operation was better associated with postoperative complications than a positive AUDIT–C score [ 31 ]. To diminish the overestimation of risky alcohol use, preoperatively, a recent randomized trial used the AUDIT–C version, however, covering only the past 3-month period instead of the original 12 months [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Identification of Alcohol Use Prior to Major Cancer Surgery: Timeline Follow Back Interview Compared to Four Other Markers

Nicklasson,

Sjödell,

Tønnesen

et al. 2024

Cancers

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Background: The postoperative complication rate is 30–64% among patients undergoing muscle-invasive and recurrent high-risk non-muscle-invasive bladder cancer surgery. Preoperative risky alcohol use increases the risk. The aim was to evaluate the accuracy of markers for identifying preoperative risky alcohol. Methods: Diagnostic test sub-study of a randomized controlled trial (STOP-OP trial), based on a cohort of 94 patients scheduled for major bladder cancer surgery. Identification of risky alcohol use using Timeline Follow Back interviews (TLFB) were compared to the AUDIT–C questionnaire and three biomarkers: carbohydrate-deficient transferrin in plasma (P–CDT), phosphatidyl-ethanol in blood (B–PEth), and ethyl glucuronide in urine (U–EtG). Results: The correlation between TLFB and AUDIT–C was strong (ρ = 0.75), while it was moderate between TLFB and the biomarkers (ρ = 0.55–0.65). Overall, sensitivity ranged from 56 to 82% and specificity from 38 to 100%. B–PEth showed the lowest sensitivity at 56%, but the highest specificity of 100%. All tests had high positive predictive values (79–100%), but low negative predictive values (42–55%). Conclusions: Despite high positive predictive values, negative predictive values were weak compared to TLFB. For now, TLFB interviews seem preferable for preoperative identification of risky alcohol use.

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Section: Discussionmentioning

confidence: 99%

“…The reduction in postoperative complications is based on the recovery from the organ dysfunctions during alcohol abstinence. However, a similar effect of reducing alcohol use remains to be demonstrated [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Identification of Alcohol Use Prior to Major Cancer Surgery: Timeline Follow Back Interview Compared to Four Other Markers

Nicklasson,

Sjödell,

Tønnesen

et al. 2024

Cancers

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“…This paper reports results of qualitative exit interviews conducted as part of the Alcohol Screening and Preoperative Intervention Research (ASPIRE) study, a randomized pilot trial of 2 preoperative alcohol interventions [ 22 ]. ASPIRE recruited 51 participants between July 2019 and February 2021 (with a pause from April to July 2020 due to COVID-19–related reductions in elective surgeries) from a large academic medical center in the Midwestern United States.…”

Section: Methodsmentioning

confidence: 99%

Reducing Alcohol Use Before and After Surgery: Qualitative Study of Two Treatment Approaches

Chapman¹,

Ren²,

Solka³

et al. 2023

JMIR Perioper Med

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Background High-risk alcohol use is a common preventable risk factor for postoperative complications, admission to intensive care, and longer hospital stays. Short-term abstinence from alcohol use (2 to 4 weeks) prior to surgery is linked to a lower likelihood of postoperative complications. Objective The study aimed to explore the acceptability and feasibility of 2 brief counseling approaches to reduce alcohol use in elective surgical patients with high-risk alcohol use in the perioperative period. Methods A semistructured interview study was conducted with a group of “high responders” (who reduced alcohol use ≥50% postbaseline) and “low responders” (who reduced alcohol use by ≤25% postbaseline) after their completion of a pilot trial to explore the acceptability and perceived impacts on drinking behaviors of the 2 counseling interventions delivered remotely by phone or video call. Interview transcripts were analyzed using thematic analysis. Results In total, 19 participants (10 high responders and 9 low responders) from the parent trial took part in interviews. Three main themes were identified: (1) the intervention content was novel and impactful, (2) the choice of intervention modality enhanced participant engagement in the intervention, and (3) factors external to the interventions also influenced alcohol use. Conclusions The findings support the acceptability of both high- and low-intensity brief counseling approaches. Elective surgical patients are interested in receiving alcohol-focused education, and further research is needed to test the effectiveness of these interventions in reducing drinking before and after surgery. Trial Registration ClinicalTrials.gov NCT03929562; https://clinicaltrials.gov/ct2/show/NCT03929562

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“…In this era of limited resources and restrictions on reimbursements for hospital readmissions (Center for Medicare and Medicaid Services, 2019), identifying patients with risky alcohol use and alcohol use disorders at highest risk for costly surgical complications could save lives and reduce cost; however, patients with risky alcohol use remain overlooked in surgical care (Fernandez et al, 2021;Shourie et al, 2007). If identified in a timely manner, those at-risk could receive preoperative alcohol interventions and referrals, and when needed alcohol withdrawal prophylaxis before or after surgery (Egholm et al, 2018;Fernandez, Chapman, et al, 2022;Tonnesen & Moller, 2006). However, alcohol screening often does not take place, takes place too close to the surgery date to facilitate timely intervention, or relies on invalid single-item questions resulting in under identification or biased identification of risky alcohol use (Fernandez et al, 2021;Kip et al, 2008;Shourie et al, 2006Shourie et al, , 2007.…”

Section: Introductionmentioning

confidence: 99%

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

Vydiswaran,

Strayhorn,

Weber

et al. 2024

Alcohol: Clinical and Experimental Research

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BackgroundPreoperative risky alcohol use is one of the most common surgical risk factors. Accurate and early identification of risky alcohol use could enhance surgical safety. Artificial Intelligence‐based approaches, such as natural language processing (NLP), provide an innovative method to identify alcohol‐related risks from patients' electronic health records (EHR) before surgery.MethodsClinical notes (n = 53,629) from pre‐operative patients in a tertiary care facility were analyzed for evidence of risky alcohol use and alcohol use disorder. One hundred of these records were reviewed by experts and labeled for comparison. A rule‐based NLP model was built, and we assessed the clinical notes for the entire population. Additionally, we assessed each record for the presence or absence of alcohol‐related International Classification of Diseases (ICD) diagnosis codes as an additional comparator.ResultsNLP correctly identified 87% of the human‐labeled patients classified with risky alcohol use. In contrast, diagnosis codes alone correctly identified only 29% of these patients. In terms of specificity, NLP correctly identified 84% of the non‐risky cohort, while diagnosis codes correctly identified 90% of this cohort. In the analysis of the full dataset, the NLP‐based approach identified three times more patients with risky alcohol use than ICD codes.ConclusionsNLP, an artificial intelligence‐based approach, efficiently and accurately identifies alcohol‐related risk in patients' EHRs. This approach could supplement other alcohol screening tools to identify patients in need of intervention, treatment, and/or postoperative withdrawal prophylaxis. Alcohol‐related ICD diagnosis had limited utility relative to NLP, which extracts richer information within clinical notes to classify patients.

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Preoperative alcohol interventions for elective surgical patients: Results from a randomized pilot trial

Cited by 6 publications

References 36 publications

Identification of Alcohol Use Prior to Major Cancer Surgery: Timeline Follow Back Interview Compared to Four Other Markers

Identification of Alcohol Use Prior to Major Cancer Surgery: Timeline Follow Back Interview Compared to Four Other Markers

Reducing Alcohol Use Before and After Surgery: Qualitative Study of Two Treatment Approaches

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

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