Alcohol Screening and Risk of Postoperative Complications in Male VA Patients Undergoing Major Non-cardiac Surgery
Alcohol Screening and Risk of Postoperative Complications in Male VA Patients Undergoing Major Non-cardiac Surgery
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DOI：
10.1007/s11606-010-1475-x
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发表时间：
2011-02-01
影响因子：
5.7
通讯作者：
Kivlahan, Daniel R.
中科院分区：
文献类型：
--
作者：
Bradley, Katharine A.;Rubinsky, Anna D.;Kivlahan, Daniel R.
背景：滥用酒精的患者发生手术并发症的风险增加。术前禁欲四周可降低并发症风险，但需要术前早期识别酒精滥用的实用方法。目的：评估手术前一年内使用酒精使用障碍识别测试-消费（AUDIT-C）问卷进行的酒精筛查结果是否与术后并发症的风险相关。设计：这是一项队列研究。地点和参与者：如果男性退伍军人事务部（VA）患者接受了重大非心脏手术评估，则他们符合资格2004-2006 财年，通过 VA 手术质量改进计划 (VASQIP) 进行了评估，并在手术前 1 年内通过邮寄调查完成了 AUDIT-C 酒精筛查问卷（0-12 分）。 主要结果指标：根据 VASQIP 护士病历审查，手术后 30 天内出现一种或多种术后并发症。 结果： 在 9,176 名符合资格的男性中， 16.3% 的 AUDIT-C 评分 >= 5 筛查出酒精滥用呈阳性，7.8% 出现术后并发症。与饮酒量较少的患者相比，AUDIT-C 评分≥ 5 的患者术后并发症的风险显着增加。在根据年龄、吸烟情况和从筛查到手术的天数进行调整的分析中，术后并发症的估计发生率从 AUDIT-C 评分 1-4 的患者中的 5.6% (95% CI 4.8-6.6%) 增加到 AUDIT-C 评分 5-8 的患者中的 7.9% (6.3-9.7%)，AUDIT-C 评分 9-10 的患者中的 9.7% (6.6-14.1%) AUDIT-Cs 11-12 的患者为 14.0% (8.9-21.3%)。在完全调整的分析中，包括术前酒精滥用和并发症之间潜在因果关系的协变量，术后并发症的估计发生率显着增加，从 AUDIT-C 评分 1-4 的患者中的 4.8% (4.1-5.7%) 显着增加到 AUDIT-C 5-8 的患者中的 6.9% (5.5-8.7%) 和 AUDIT-C 评分为 5-8 的患者中的 7.5% (5.0-11.3%)。 AUDIT-Cs 9-10。结论：手术前一年内 AUDIT-C 评分为 5 分或以上与术后并发症增加相关。
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.