Worth the Risk? Standardized Screening to Identify Substance Use Among Patients Before Surgery

We sought to compare the identification of unhealthy substance use before surgery using Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS), a standardized 4-item instrument, versus routine clinical documentation in the electronic medical record (EHR).

Over 20% of individuals exhibit unhealthy substance use before elective surgery. Routine EHR documentation is often based on nonstandard questions that may not fully capture the extent of substance use and are subject to bias. In contrast, brief standardized screening could provide a more efficient and systematic approach.

We conducted a cross-sectional study among adults (≥18 y) at a preoperative clinic from August to September 2021. Positive screens for unhealthy substances by TAPS were compared with data from the EHR. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were reported. Receiver operating characteristic curves were used to assess diagnostic ability. Multivariable logistic regression was used to estimate the predictors of positive screens by TAPS.

The cohort included 240 surgical patients. TAPS screening identified significantly more positive screens than EHR documentation (43.3% vs. 14.2%). Patients with unhealthy substance use were younger (50.8 vs. 56.7 y; P =0.003), and TAPS revealed alcohol misuse in 30.8% of cases, contrasting with 0% in clinician documentation ( P <0.001). Of the 104 TAPS-positive patients, 69.2% were missed by EHR documentation. Sensitivity (31%) and accuracy (AUC=0.65) of clinician documentation for any unhealthy substance use were lower compared with TAPS.

Standardized TAPS screening detected preoperative unhealthy substance use more frequently than routine clinician documentation, emphasizing the need for integrating standardized measures into surgical practice to ensure safer perioperative care and outcomes.