Bridging the Gap: Implementation and Uptake of AUDIT-C Alcohol Screening for Inpatient Surgery

To evaluate the feasibility of Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening among surgical inpatients following hospital-wide implementation of a quality improvement initiative.

Risky alcohol use increases postoperative complications, yet alcohol screening for surgery remains inconsistently applied. As a brief, validated screening tool, the AUDIT-C may improve risk assessment and guide timely intervention, but its adoption in surgical settings is understudied.

We retrospectively analyzed electronic health record data from inpatient surgical admissions between April 2021 and September 2023. The primary outcome was completion of a valid AUDIT-C score during admission. Scores were categorized as no use (0), low-risk (1-4), moderate-risk (5-8), and high-risk (9-12). Multivariable logistic regression assessed independent associations with AUDIT-C screening completion.

Among 30,714 encounters, 9540 (31.1%) had a completed AUDIT-C score. Screening completion varied by surgical service (15.2%-52.4%) and was higher in emergent (51.7%) and urgent (48.4%) cases than elective (29.1%) cases. The 3 most frequently performed procedures screened 53.8% (cesarean), 42.8% (free flap), and 11.6% (aortic valve) of patients. In multivariable models, emergent case status [marginal effect (ME): 0.14], urgent case status (ME: 0.09), and Medicare insurance (ME: 0.03) were independently associated with higher odds of screening completion. Among those screened, 6.5% were classified as moderate- or high-risk.

Perioperative alcohol screening using AUDIT-C is feasible but inconsistently implemented. System-wide integration could support identification of at-risk patients and improve perioperative outcomes.