AUDIT-C Alcohol Screening Results as a Marker of Alcohol Misuse Severity and Postoperative Risk

Alcohol misuse is a modifiable risk factor for postoperative complications and health care utilization. The AUDIT-C alcohol screening questionnaire is commonly used for routine alcohol screening in primary care and results up to a year before surgery can identify patients with increased postoperative complications. Study 1 investigated whether past-year AUDIT-C screening results can also identify patients with increased postoperative inpatient health care utilization. Using data from a sample of male Veterans Affairs (VA) surgical patients who completed the 3-item AUDIT-C on mailed surveys up to a year prior to surgery, this study demonstrated that past-year AUDIT-C screening results identified a subset of the highest risk drinkers who had increased postoperative health care utilization. Study 2 evaluated whether clinical documentation of risky drinking immediately prior to surgery modified estimates of postoperative complications and health care utilization associated with AUDIT-C results up to a year before surgery in a similar sample of VA men. Associations between higher AUDIT-C scores and most measures of postoperative risk were found to be limited to those patients who had documented risky drinking immediately prior to surgery. Study 3 investigated the level of alcohol consumption associated with specific AUDIT-C scores in a large U.S. population sample and found that, among older adults of similar age to the VA surgical population, AUDIT-C scores associated with increased postoperative complications (≥ 5 points) and health care utilization (≥ 9 points) reflected drinking > 2 and ≥ 5 drinks per day, respectively. The finding that the combination of AUDIT-C score from up to a year before surgery and clinical documentation of risky drinking in the two weeks prior to surgery provided more information about postoperative risk than either measure alone suggests that in healthcare systems that use the AUDIT-C for routine alcohol screening, such as the VA, patients with a documented prior positive screen could be re-assessed closer to the time of surgery to identify those who continue to drink at risky levels. These patients may be at greatest risk for postoperative complications and increased postoperative health care utilization.