Elsevier

Surgery

Volume 152, Issue 1, July 2012, Pages 69-81
Surgery

Original Communication
Prevalence of alcohol misuse among men and women undergoing major noncardiac surgery in the Veterans Affairs health care system

https://doi.org/10.1016/j.surg.2012.02.007Get rights and content

Background

Patients who screen positive for alcohol misuse on the Alcohol Use Disorder Identification Test Consumption Questionnaire (AUDIT-C ≥5 points) have significantly increased postoperative complications. Severe alcohol misuse (AUDIT-C ≥9 points) is associated with increased postoperative health care use; however, little is known about the prevalence of alcohol misuse in demographic and clinical subgroups of surgical patients.

Methods

The prevalence of alcohol misuse was evaluated among 10,284 patients (9,771 men and 513 women) who underwent major noncardiac surgery in Veterans Affairs (VA) hospitals during the fiscal years 2004 to 2006 and completed the AUDIT-C. Sex-stratified analyses evaluated prevalence rates of alcohol misuse (AUDIT-C ≥5) and severe misuse (AUDIT-C ≥9) across demographic and clinical subgroups.

Results

Overall, 1,607 (16%) men and 24 (5%) women screened positive for alcohol misuse (AUDIT-C ≥5) in the year before operation, with 4% and 2% screening positive for severe misuse (AUDIT-C ≥9), respectively. Alcohol misuse was more common among men who were <60 years of age, divorced or separated, current smokers, or American Stoke Association class 1 or 2, and those with cirrhosis/hepatitis or substance use disorders. Among patients with alcohol misuse, 36% of men and 58% of women were American Society of Anesthesiologists class 1 or 2, and most did not have diagnoses that were commonly associated with alcohol misuse.

Conclusion

Alcohol misuse is relatively common in male surgical patients. Moreover, surgical patients undergoing operation who screen positive for alcohol misuse are often relatively healthy, without health problems that might alert providers to their alcohol misuse in the absence of screening.

Section snippets

Data sources

This study used quality improvement and administrative data from 4 sources as described below.

Results

A total of 287,060 Veterans were eligible for inclusion in VASQIP during the study. Of these, 10,284 patients (9,771 men and 513 women) had an operation assessed by VASQIP, were sampled randomly for the SHEP survey, and completed the alcohol screening questions (AUDIT-C) on SHEP in the year before the operation, making them eligible for this study. Demographic characteristics and preoperative clinical characteristics of the study sample are shown in Table II. Patient ages ranged from 21 to ≥90

Discussion

Sixteen percent of men and 5% of women in this national sample of VA patients undergoing surgery screened positive for alcohol misuse on the AUDIT-C at levels associated with increased postoperative complications.15 In men, the prevalence of alcohol misuse exceeded 10% in all subgroups evaluated except 2: men >70 years of age and men with renal disease. More than a quarter of men who smoked cigarettes screened positive for alcohol misuse, although the prevalence of alcohol misuse was less among

References (38)

  • T. Neumann et al.

    Value of ethyl glucuronide in plasma as a biomarker for recent alcohol consumption in the emergency room

    Alcohol Alcohol

    (2008)
  • T. Neumann et al.

    Screening trauma patients with the alcohol use disorders identification test and biomarkers of alcohol use

    Alcohol Clin Exp Res

    (2009)
  • M.J. Kip et al.

    New strategies to detect alcohol use disorders in the preoperative assessment clinic of a German university hospital

    Anesthesiology

    (2008)
  • L. Kriston et al.

    Meta-analysis: are 3 questions enough to detect unhealthy alcohol use?

    Ann Intern Med

    (2008)
  • K. Bush et al.

    The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test

    Arch Intern Med

    (1998)
  • K.A. Bradley et al.

    AUDIT-C as a brief screen for alcohol misuse in primary care

    Alcohol Clin Exp Res

    (2007)
  • K.A. Bradley et al.

    Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population

    Arch Intern Med

    (2003)
  • S. Shourie et al.

    Pre-operative screening for excessive alcohol consumption among patients scheduled for elective surgery

    Drug Alcohol Rev

    (2007)
  • K.A. Bradley et al.

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

    J Gen Intern Med

    (2011)
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    Supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development and Health Services Research and Development (HSR&D; project IAC 06-021). Dr Bradley was an investigator at the Veterans Affairs Northwest HSR&D Center of Excellence and at the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, while this work was conducted.

    This material is based upon work supported by the US Department of Veterans Affairs, Office of Research and Development. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

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