Should Surgeons Postpone Procedures for Heavy Drinkers?
"Additionally, on average these [high-risk] patients will spend six days in the hospital following surgery, 4.5 of which will be in the ICU," she says.
The surgical patients were categorized according to the Alcohol Use Disorders Identification Test (AUDIT-C), with the highest risk level of alcohol misusers identified as "AUDIT-C 9-12"—those who drink four alcoholic beverages a day.
One alcoholic beverage was defined as 12 ounces of beer, or 5 ounces of table wine, or 1.5 ounces of liquor.
Rubinsky says that about 8.6% of those scoring AUDIT-C 5-8, the mid-level category of risk, and 11.8% of those with AUDIT-C 9-12 scores, experienced postoperative complications, compared to 6.3% of those in the lowest category of alcohol users, AUDIT-C 1-4 scores.
For medical providers considering whether to refer their patients for surgery, Rubinsky suggests that primary care physicians or nurse coordinators run AUDIT-C screens in elective surgery candidates.
She says that at least one prior study of patients undergoing colectomies "found that a month of pre-operative abstinence, supported by monitored disulfiram (Antabuse) use, significantly decreased postoperative complications" in patients with a history of four or more drinks per day.
The VA study was conducted through questionnaires mailed to male patients, the majority of whom were white, over age 60, and married, and includes those who were hospitalized for a non-emergent, non-cardiac major surgery the following year.
Rubinsky cautions that she and her co-authors "do not think that it would be appropriate to refuse a patient a surgery without additional evidence from randomized controlled trials demonstrating that reducing and/or abstaining from alcohol use decreases post-operative complications in patients who drink at this level."
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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