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Association between inpatient AUDIT-C alcohol screening scores and postoperative outcomes: a retrospective cohort
Toby Chen1, Anne C Fernandez2, Sarah Evilsizer1,3
1Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
Objectives:
To evaluate whether alcohol use severity, as measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), is associated with postoperative complications, hospital utilisation and opioid prescribing among adult surgical inpatients.
Design:
Retrospective cohort study.
Setting:
Single tertiary academic hospital in the USA, using data from inpatient surgical admissions between April 2021 and September 2023.
Participants:
Adult patients (≥18 years) admitted for inpatient surgery with a completed AUDIT-C screening during their admission.
Measures:
AUDIT-C scores were categorised as at-risk (≥5 for men, ≥4 for women) or low risk (other non-zero scores). Patients with AUDIT-C scores of 0 were described in the cohort but excluded from the primary comparative analyses to account for potential J-shaped associations between abstinence and health outcomes. The primary outcome was a composite of surgical complications, emergency department visits, hospital readmissions or mortality within 30 days of surgery. Secondary outcomes included hospital length of stay and postoperative opioid prescribing from discharge through 6 months. Univariable and multivariable logistic regression models were used to evaluate associations between AUDIT-C scores and postoperative outcomes. Additional analyses included Kaplan-Meier survival analysis, receiver operating characteristic curves and feature importance modelling.
Results:
9538 (31.1%) of 30 708 eligible surgical patients completed the AUDIT-C, and screening was more common among younger, healthier patients. Among screened patients, 5440 (57.0%) were female and 7405 (77.6%) identified as non-Hispanic White. A total of 805 (8.4%) of screened patients reported at-risk alcohol use. The primary outcome, composite adverse postoperative outcomes, occurred in 13.9% of low-risk patients and 14.5% of at-risk patients (p=0.637). In unadjusted analyses, no significant differences were observed between alcohol risk groups for individual postoperative outcomes, including complications, 30-day readmissions, emergency department visits or mortality. Multivariable logistic regression confirmed no association between AUDIT-C category and the primary composite outcome (average marginal effect 0.01, 95% CI -0.02 to 0.03). Median hospital length of stay differed slightly between groups (3.0 days (IQR 4.0) vs 3.0 days (IQR 5.0); p=0.01). In adjusted Cox proportional hazards modelling, at-risk alcohol use was associated with a slightly lower hazard of discharge compared with low-risk alcohol use, corresponding to a modestly longer time to discharge (HR=0.92, p=0.041). Time to readmission did not differ significantly. Opioid prescribing at discharge was similar across groups (58.4% vs 58.9%, p=0.763).
Conclusions:
In this real-world surgical cohort, observed AUDIT-C risk category among patients who completed screening was not significantly associated with short-term postoperative outcomes or opioid prescribing. While small differences in length of stay reached statistical significance, their clinical relevance is uncertain. Limitations include limited number of at-risk patients, non-response bias and the absence of standardised follow-up for at-risk patients, which may have contributed to null findings. Future efforts should focus on improving screening through workflow integration, surgical team engagement and follow-up interventions to fully realise benefits from alcohol screening.