An added concern to medical professionals is that the pre-surgical screening process does not always identify those patients who drink too much, according to Dr. Harrison Weed of The Ohio State University Wexner Medical Center. He said among the general population, respondents may not perceive their own drinking habits as being unhealthy, or they may be reluctant to admit a known problem.
Another barrier can be the standard alcoholism screening questionnaire that is used to obtain information.
Designed to flag drinking behavior that impairs health or social function, standard questionnaires don’t perform well when it comes to identifying drinking problems that can cause post-surgery complications.
Weed and a team of Ohio State physicians studied ways to improve and streamline the screening process and discovered that two key questions were sufficient to alert healthcare professionals to a drinking problem than can cause post-surgical complications.
“Alcohol use is a very sensitive topic for many people and standard screening questions often don’t elicit forthright or accurate responses,” said Weed, an internal medicine physician who was the lead investigator for a study on alcohol-related predictors of postoperative delirium that is published in the recent issue of Archives of Otolaryngology -- Head and Neck Surgery.
Weed asked hundreds of patients preparing for surgery a series of questions to detect problem drinking. Researchers then reviewed hospital records to determine which of the patients had delirium after surgery. Delirium tremens, a severe form of alcohol withdrawal, elevates the risk of post surgical complications three-fold and increases the risk of death. It’s estimated that 10 percent of the U.S. population drinks alcohol excessively.
Because there is no blood test or physical examination finding that can reliably detect alcoholism, medical professionals must rely on a patient’s answers to specific questions to help identify people at risk for medical complications.
In their research, Weed and his colleagues reviewed the medical records of 774 patients who underwent major head and neck squamous cell cancer surgery. Patients with this particular type of cancer have a high prevalence of heavy alcohol consumption and a high incidence of postoperative delirium. Ninety-two surgeries (11.5 percent) were complicated by postoperative delirium.
The researchers found that two questions helped best predict who would have delirium after surgery: “At any time in your life, has anyone ever suggested that you should cut back on your drinking?” and “What is the greatest number of days in a row you have gone without an alcoholic drink in the past year?”
After accounting for other known causes of postoperative delirium, including advanced age (older than age 69), pre-existing cognitive impairment and length of surgery, patients who reported ever being advised to cut back on drinking had twice the risk of delirium and those reporting not abstaining for at least a week in the prior year had an additional doubling in their risk.
One blood test also predicted postoperative delirium. A large red blood cell mean corpuscular volume (MCV) was associated with an additional doubling in the risk of postoperative delirium. Daily heavy alcohol consumption is known to sometimes cause a large MCV.
Asking patients the two questions is now a routine part of the admission process at Ohio State. Patients identified as being at risk are monitored more closely using a standardized protocol, and, if needed, given treatment that reduces the risk of delirium tremens.
Other researchers involved in the study were Summit Shah, Xin He, Amit Agrawal, Enver Ozer and David Schuller.
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