Study Uncovers Sobering Facts About Alcohol Abuse Detection in Surgical Patients

Newswise — A study in this month's Anesthesiology found evidence that alcohol use disorders (AUDs) are frequently overlooked in patients undergoing surgery "• but also touts a very simple and effective method to identify patients who may be at risk for alcohol-related perioperative complications.

In the AUD study, anesthesiologist Claudia D. Spies, M.D., and her research group from Charite-Universitaetsmedizin Berlin studied 1,556 surgical patients and found a trend of missed opportunities in identifying those at risk.

"First, we noted that AUD is not diagnosed adequately during preoperative assessment," said Dr. Spies. "Then, even if a finding of AUD was made before surgery, preventive measures were not often undertaken. This is significant because patients with AUD have three to four times more complications during and around the time of surgery than patients without AUD."

According to Dr. Spies, an important key to detection may lie in a computerized self-assessment tool called AUDIT, or the Alcohol Use Disorder Identification Test. When AUDIT was used, over twice as many patients with AUD were identified compared to the standard preoperative interview.

Part of AUDIT's success (when compared to physicians' interviews alone) may be due in part to physicians' lack of training in preoperative screening for alcohol use and also the more anonymous nature of the computerized test itself.

"Patients seem to be more confident in answering questions about their alcohol use in a computer-based question-and-answer format," said Dr. Spies.

Although it appears that a more accurate assessment of alcohol use is obtained when the human element is removed from the screening process, it is exactly that human element that is crucial to the success of strategies dealing with an enormous societal problem, said Dr. Spies.

"Anesthesiologists can play an important role in preventing severe consequences of AUD and thereby contributing to an improvement in public health," she said. "Preoperative screening for AUD provides not only the opportunity to select patients for preventive medical interventions but also allows us to screen large and diverse patient populations for at-risk drinkers whose behavior my become dangerous at some point in the future."

In 2006, the World Health Organization reported that alcohol use was the third highest risk factor for death and disability in the general population of Europe and the leading risk factor for young Europeans.

Dr. Spies' study found that an overwhelming majority of physicians neglected to use well-documented tools for AUD detection, perhaps because they were uncomfortable in questioning patients about alcohol consumption.

"Physicians tend to underestimate and miss AUD in younger patients, especially young female patients," she said. "Our results emphasize that the use of computer-based screening methods, such as AUDIT, applied to every patient, are effective in addressing these biases."

When AUD is properly identified, physicians can then begin the important step of intervention strategies that might include a brief motivational interview or tailored advice, said. Dr. Spies. Patients desiring long-term assistance in changing their drinking habits can then be referred to a specialist in the field.

Dr. Spies' research is the first to systematically study the effectiveness of a computerized version of the AUDIT test in a preoperative assessment clinic. And although it found inadequate diagnoses among many health care professionals, the study offers simple solutions to a complex problem and should serve as a wake-up call to physicians the world over.

"The enormous amount of well-conducted research into AUD and its social, physical and psychological consequences will not yield the benefits it should if we fail to implement strategies for the detection of AUD into daily clinical practice," said Dr. Spies.

This study underscores recent efforts by anesthesiologists to address lifestyle issues affecting patients' health, such as the American Society of Anesthesiologists' smoking cessation campaign initiated earlier this year.

For more information visit the American Society of Anesthesiologists Web site at www.asahq.org and the journal Anesthesiology site at http://www.anesthesiology.org.

Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 43,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.