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

被引：82

作者：

Bradley, Katharine A. ^{[1
,2
,3
,4
]}

Rubinsky, Anna D. ^{[1
,4
]}

Sun, Haili ^{[1
]}

Bryson, Chris L. ^{[1
]}

Bishop, Michael J. ^{[8
,11
]}

Blough, David K. ^{[1
,10
]}

Henderson, William G. ^{[5
,12
]}

Maynard, Charles ^{[1
,4
]}

Hawn, Mary T. ^{[13
,16
]}

Tonnesen, Hanne ^{[14
]}

Hughes, Grant ^{[5
]}

Beste, Lauren A. ^{[1
,4
]}

Harris, Alex H. S. ^{[6
]}

Hawkins, Eric J. ^{[1
,2
,9
]}

Houston, Thomas K. ^{[7
,15
]}

Kivlahan, Daniel R. ^{[1
,2
,9
]}

机构：

[1] Dept Vet Affairs Puget Sound Hlth Care Syst, Seattle, WA 98101 USA

[2] Ctr Excellence Subst Abuse Treatment & Educ, Dept Vet Affairs VA Puget Sound Hlth Care Syst, Seattle, WA USA

[3] Univ Washington, Dept Med, Seattle, WA USA

[4] Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA

[5] Dept Vet Affairs Eastern Colorado Healthcare Syst, Denver, CO USA

[6] Ctr Hlth Care Evaluat, Dept Vet Affairs Palo Alto Hlth Care Syst, Menlo Pk, CA USA

[7] Bedford VAMC, Ctr Hlth Qual Outcomes & Econ Res, Bedford, TX USA

[8] Anesthesia Serv, Dept Vet Affairs, Cent Off, Washington, DC USA

[9] Univ Washington, Dept Psychiat & Behav Sci, Seattle, WA 98195 USA

[10] Univ Washington, Dept Pharm, Seattle, WA 98195 USA

[11] Univ Washington, Dept Anesthesiol, Seattle, WA 98195 USA

[12] Univ Colorado, Hlth Outcomes Program, Aurora, CO USA

[13] Univ Alabama Birmingham, Dept Surg, Birmingham, AL 35294 USA

[14] Bispebjerg Hosp, WHO Collaborating Ctr Evidence Based Hlth Promot, Copenhagen, Denmark

[15] Univ Massachusetts, Sch Med, Dept Quantitat Hlth Sci, Div Hlth Informat & Implementat Sci, Worcester, MA USA

[16] Birmingham Vet Affairs Med Ctr, Ctr Surg Med Acute Care Res & Transit C SMART, Birmingham, AL USA

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 2011年 / 26卷 / 02期

关键词：

alcohol screening; surgical outcomes; AUDIT-C; PRIMARY-CARE VALIDATION; UPPER DIGESTIVE-TRACT; SURGICAL CARE; ELECTIVE SURGERY; MALE VETERANS; USE DISORDERS; AUDIT-C; QUALITY; MORBIDITY; SCORES;

D O I：

10.1007/s11606-010-1475-x

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

100404 [儿少卫生与妇幼保健学];

摘要：

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.

引用

页码：162 / 169

页数：8

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