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Scientific Articles   |    
Preoperative Alcohol Screening Scores: Association with Complications in Men Undergoing Total Joint Arthroplasty
Alex H.S. Harris, PhD, MS1; Rachelle Reeder, BA1; Laura Ellerbe, MS1; Katharine A. Bradley, MD2; Anna D. Rubinsky, PhD2; Nicholas J. Giori, MD3
1 Center for Health Care Evaluation, 795 Willow Road (MPD-152), Menlo Park, CA 94025. E-mail address for A.H.S. Harris: Alexander.Harris2@va.gov
2 Health Services Research and Development (152), Department of Veterans Affairs, Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101
3 Bone and Joint Rehabilitation Research and Development Center, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the VA Palo Alto Health Care System, Palo Alto, California
Disclaimer: The views expressed herein are not necessarily those of the Department of Veterans Affairs.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Feb 16;93(4):321-327. doi: 10.2106/JBJS.I.01560
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Abstract

Background: 

The risks associated with preoperative alcohol misuse by patients before undergoing total joint arthroplasty are not well known, yet alcohol misuse by surgical patients is common and has been linked to an increased risk of complications after other procedures. The purpose of this study was to evaluate the association between a patient's preoperative standardized alcohol-misuse screening score and his or her risk of complications after total joint arthroplasty.

Methods: 

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is an alcohol-misuse screening instrument administered annually to all patients receiving care through the Veterans Health Administration (VHA). The scores range from 0 to 12, with higher scores signifying greater and more frequent consumption. In a study of 185 male patients who had alcohol screening scores recorded in the year preceding surgery at a Palo Alto VHA facility, and who reported at least some alcohol use, we estimated the association between preoperative screening scores and the number of surgical complications in an age and comorbidity-adjusted regression analyses.

Results: 

Of the 185 patients reporting at least some drinking in the year before their total joint replacement, 17% (thirty-two) had an alcohol screening score suggestive of alcohol misuse; six of those thirty-two patients had one complication, four had two complications, and two had three complications. The screening scores were significantly related to the number of complications in a negative binomial regression analysis (exp[ß] = 1.29, p = 0.035), which demonstrated a 29% increase in the expected number of complications with every additional point of the screening score above 1, although with wide confidence intervals for the higher scores.

Conclusions: 

Complications following total joint arthroplasty were significantly related to alcohol misuse in this group of male patients treated at a VHA facility. The AUDIT-C has three simple questions that can be incorporated into a preoperative evaluation and can alert the treatment team to patients with increased postoperative risk. Preoperative screening for alcohol misuse, and perhaps preoperative counseling or referral to treatment for heavy drinkers, may be indicated for patients who are to undergo total joint arthroplasty.

Level of Evidence: 

Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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