Surgeons could reduce length of hospital stay, time in the ICU, or the likelihood of a repeat operation if they postpone procedures for patients who consume lots of alcohol to give them time to stop.
That's the suggestion from a new study of 5,171 male patients of the Veterans Affairs healthcare system published in the March issue of the Journal of the American College of Surgeons. The reportindicates that patients who drink four or more glasses of alcohol a day have significantly higher post-surgical complication rates than those who drink moderately or not at all.
But getting heavy drinkers to stop for just 30 days reduces that complication risk substantially, the authors say.
"Among 1,000 male VA surgical patients who screen positive for alcohol misuse in the year before surgery...an estimated 118 will experience post-operative complications and approximately 110 will return to the operating room within 30 days of surgery," says Anna Rubinsky, a researcher at the VA Puget Sound Health Care System in Seattle and the paper's lead author.
High-risk drinkers "on average spent nearly a day longer in the hospital, had 1.5 more ICU days, and were twice as likely to return to the operating room compared with low-risk drinkers" after adjusting for sociodemographic variables, smoking, and surgical category, said her report.
"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."