Hamburg - Alcohol abuse is often overlooked by surgeons before patients are administered anaesthetics prior to surgery, with possibly hazardous results, according to a team of German researches. Writing in the current journal Anaesthesiology, the researchers found evidence that alcohol use disorders (AUDs) routinely go unnoticed in patients undergoing surgery.
But the researchers said there is a very simple and effective method of identifying patients who may be at risk of alcohol-related perioperative complications, according to a news release by the American Society of Anaesthesiologists.
In the AUD study, anaesthesiologist Claudia D Spies and her research group from Charite University Hospital in 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.
Patients tend to understate their alcohol consumption during preoperative interviews with surgeons, the researchers found. This is particularly true of younger patients, especially young women, who show no physical symptoms of alcohol-related disorders. In addition many physicians lack training in preoperative screening for alcohol use. So the AUDIT computerized test provides a more anonymously objective means of determining a person's drinking habits.
"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.
"Anaesthesiologists 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 behaviour 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 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 anaesthesiologists to address lifestyle issues affecting patients' health, such as the American Society of Anaesthesiologists' smoking cessation campaign initiated earlier this year.
