AUDIT-C Alcohol Screening Results and Postoperative Inpatient Health Care Use

Background

Alcohol screening scores ≥5 on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) up to a year before surgery have been associated with postoperative complications, but the association with postoperative health care use is unknown. This study evaluated whether AUDIT-C scores in the year before surgery were associated with postoperative hospital length of stay, total ICU days, return to the operating room, and hospital readmission.

Study Design

This cohort study included male Veterans Affairs patients who completed the AUDIT-C on mailed surveys (October 2003 through September 2006) and were hospitalized for nonemergent noncardiac major operations in the following year. Postoperative health care use was evaluated across 4 AUDIT-C risk groups (scores 0, 1 to 4, 5 to 8, and 9 to 12) using linear or logistic regression models adjusted for sociodemographics, smoking status, surgical category, relative value unit, and time from AUDIT-C to surgery. Patients with AUDIT-C scores indicating low-risk drinking (scores 1 to 4) were the referent group.

Results

Adjusted analyses revealed that among eligible surgical patients (n = 5,171), those with the highest AUDIT-C scores (ie, 9 to 12) had longer postoperative hospital length of stay (5.8 [95% CI, 5.0−6.7] vs 5.0 [95% CI, 4.7−5.3] days), more ICU days (4.5 [95% CI, 3.2−5.8] vs 2.8 [95% CI, 2.6−3.1] days), and increased probability of return to the operating room (10% [95% CI, 6−13%] vs 5% [95% CI, 4−6%]) in the 30 days after surgery, but not increased hospital readmission within 30 days postdischarge, relative to the low-risk group.

Conclusions

AUDIT-C screening results could be used to identify patients at risk for increased postoperative health care use who might benefit from preoperative alcohol interventions.

Abbreviations and Acronyms:  AUDIT-C, Alcohol Use Disorders Identification Test–Consumption, CPT, Current Procedural Terminology, LOS, length of stay, NPCD, National Patient Care Database, OR, operating room, RVU, relative value unit, SHEP, Survey of Healthcare Experiences of Patients, VA, Veterans Affairs, VASQIP, Veterans Affairs Surgical Quality Improvement Program