You are here

Article Text

Article menu

Download PDFPDF

Original article
Identifying chronic heavy alcohol use in emergency general surgery patients: a pilot study
  1. Maher M Matar1,
  2. Brent Jewett2,
  3. Samir M Fakhry1,
  4. Dulaney A Wilson1,
  5. Pamela L Ferguson1,
  6. Raymond F Anton1,3,
  7. Joseph V Sakran1,4
  1. 1Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of Surgery, Trident Medical Center, Charleston, South Carolina, USA
  3. 3The Charleston Alcohol Center, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4Division of Acute Care Surgery, The Johns Hopkins University, The Johns Hopkins Hospital, Baltimore, Maryland, USA
  1. Correspondence to Dr Joseph V Sakran, Division of Acute Care Surgery, The Johns Hopkins University, 1800 Orleans Street, Sheikh Zayed Tower, Baltimore, Maryland 21287, USA; jsakran1{at}jhmi.edu

Abstract

Background Chronic heavy alcohol (CHA) use has been associated with perioperative complications. Emergency general surgery (EGS) patients are not routinely screened for CHA. If screened, it is usually for hazardous use of alcohol, using a survey such as the Alcohol Use Disorders Identification Test (AUDIT). This study screened EGS patients for CHA use using serum carbohydrate-deficient transferrin (%dCDT) level, a biomarker that has been validated as an indicator for CHA use, as well as the AUDIT. The purpose of this study was to determine the percent of EGS patients with CHA (as indicated by elevated %dCDT), and the relationship between %dCDT and AUDIT. Secondary aims included comparing the characteristics of EGS patients with and without CHA use, and evaluating the association of CHA use with negative clinical outcomes.

Methods EGS patients aged 21 and older admitted to the general surgery inpatient service of a tertiary hospital from July 2014 to June 2016 were invited to participate in this study. %dCDT levels above 1.7% were considered positive for CHA use, as were AUDIT scores ≥8.

Results 195 EGS patients were screened for inclusion and 91 (46.7%) agreed to participate. 14 (15.4%) were positive for hazardous alcohol use on AUDIT and 5 (5.5%) were positive for CHA by %dCDT. Positive predictive value of AUDIT for CHA was 21.4%. There was no correlation between positive scores on AUDIT and %dCDT.

Discussion Identifying at risk patients early on in their hospital course may allow clinicians to institute treatments to mitigate and/or circumvent complications in such patients. This pilot study determined that 17.6% of participating EGS patients were positive for some type of alcohol misuse, but only 5.5% had CHA. Further research is needed to determine whether routine use of %dCDT would be beneficial in reducing perioperative complications in this patient population.

Level of evidence III (diagnostic test).

  • alcohol use
  • acute care surgery
  • Carbohydrate Deficient Transferrin %dCDT
  • Alcohol Use Disorders Identification Test AUDIT

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2017-000098

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors Study design: JVS, SMF, PLF, RFA, BJ. Literature search: MMM, BJ, JVS, PLF. Data collection/analysis/interpretation: MMM, BJ, SMF, DAW, PLF, RFA, JVS. Writing: MMM, JVS, SMF, PLF, DAW, RFA.

    • Funding Charleston Alcohol Research Center - Medical University of South Carolina (Grant# P50AA010761).

    • Competing interests None declared.

    • Ethics approval Medical University of South Carolina’s Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.