Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery

Abstract

Background: Patients who misuse alcohol are at increased risk for surgical complications. Four weeks of preoperative abstinence decreases the risk of complications, but practical approaches for early preoperative identification of alcohol misuse are needed.

Objective: To evaluate whether results of alcohol screening with the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) questionnaire-up to a year before surgery-were associated with the risk of postoperative complications.

Design: This is a cohort study.

Setting and participants: Male Veterans Affairs (VA) patients were eligible if they had major noncardiac surgery assessed by the VA's Surgical Quality Improvement Program (VASQIP) in fiscal years 2004-2006, and completed the AUDIT-C alcohol screening questionnaire (0-12 points) on a mailed survey within 1 year before surgery.

Main outcome measure: One or more postoperative complication(s) within 30 days of surgery based on VASQIP nurse medical record reviews.

Results: Among 9,176 eligible men, 16.3% screened positive for alcohol misuse with AUDIT-C scores ≥ 5, and 7.8% had postoperative complications. Patients with AUDIT-C scores ≥ 5 were at significantly increased risk for postoperative complications, compared to patients who drank less. In analyses adjusted for age, smoking, and days from screening to surgery, the estimated prevalence of postoperative complications increased from 5.6% (95% CI 4.8-6.6%) in patients with AUDIT-C scores 1-4, to 7.9% (6.3-9.7%) in patients with AUDIT-Cs 5-8, 9.7% (6.6-14.1%) in patients with AUDIT-Cs 9-10 and 14.0% (8.9-21.3%) in patients with AUDIT-Cs 11-12. In fully-adjusted analyses that included preoperative covariates potentially in the causal pathway between alcohol misuse and complications, the estimated prevalence of postoperative complications increased significantly from 4.8% (4.1-5.7%) in patients with AUDIT-C scores 1-4, to 6.9% (5.5-8.7%) in patients with AUDIT-Cs 5-8 and 7.5% (5.0-11.3%) among those with AUDIT-Cs 9-10.

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

Figure 1

Study sample.

Figure 2

Prevalence of postoperative complications across AUDIT-C surgical risk groups. Adjusted prevalence rates and 95% confidence intervals estimated from random effects logistic regression, Model 1, adjusted for age, smoking and time from AUDIT-C to surgery, and Model 2, fully-adjusted, with p values for comparison with the referent group (AUDIT-C scores 1-4). † Total complications = one or more of the 20 postoperative complications assessed by VASQIP in the 30 postoperative days.