Alcohol + anesthesia + surgery: not a good mix?

8.3% of Americans have a drinking disorder. Europeans drink even more, and alcohol is the third highest risk factor for death and disability in the general population.

The August 2008 edition of Anesthesiology reports that in a German preoperative clinic, 6.9% of patients were determined by an anesthesiologist to have an alcohol use disorder.  That would seem to be in keeping with the population studies cited above, but a 10-question computerized identification test identified more than twice as many patients – 18.1% – as problem drinkers. Those Berliners really know how to party!

This is actually not surprising. Computerized assessments of alcohol consumption have been used as far back as 1977.  Forty years of study have shown that computers do a better job than people in detecting these kinds of problems reliably and at low cost.  People are actually more likely to disclose problems of a personal nature, including mental health issues, to a computer than to your average medical interviewer.

Is it important to know before surgery whether you drink excessively? Well, if you have more than six alcoholic drinks a day you are at increased risk of alcohol withdrawal syndrome, infection, sepsis, bleeding, acute cardiac (heart) events, and even death.

If you are a heavy drinker and can stop drinking entirely for 4 weeks you may have fewer complications. This was shown in one study of patients undergoing colon surgery.

Surgery is a good time to address problem drinking before irreversible damage has been done to your health. So, should screening for alcohol abuse be done routinely? Alcohol screening and counseling is apparently as cost-effective as screening for colon cancer, high blood pressure, and flu vaccination but is not done very commonly.

Based on this evidence from Germany, an accompanying editorial in Anesthesiology suggests “computer-based screening could improve the efficiency of alcohol screening in the preoperative population.” That conclusion seems hard to argue with.

The editorial suggests that a “brief intervention” could be helpful, such as “ a short statement of concern …that the patient’s drinking exceeds recommended limits and may lead to future problems, with a recommendation to limit alcohol intake or stop drinking”.  There is no evidence so far that this is likely to have results, but it is a zero cost intervention that might help the occasional person.

More intensive counseling interventions are also described.  It’s probable that around the time of surgery, people confronted with the long list of potential complications related to their problem drinking, are likely to be motivated to curtail or stop their alcohol intake. This certainly seems to be the case with cigarette smoking and has lead to campaigns to identify smokers before surgery and help them quit.

It seems that some anesthesiologists, or those in academic practice anyway, are increasingly promoting a public health perspective and even advocating a condition-specific primary care role in certain circumstances.

My own SurgiPrep™ preoperative interview system (http://www.surgiprep.com) probes gently for excess use of alcohol with a single question that has been endorsed by World Health Organization as a reliable screen.  Of course there are also questions about smoking, drug and alcohol use.

What you can do

  • One or two alcoholic drinks a day are probably not harmful and may even do some people some good.
  • It’s usually okay to have a drink with supper the night before your operation. But check with your doctors. Cheers!
  • Those who drink more heavily ought to abstain, or cut back, for a month or so before major surgery.
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