COLUMBUS,
Ohio – Alcohol use, a known risk factor for complications after surgery, can
cause delirium, bleeding, infections and other serious health problems that
often result in longer hospital stays.
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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Contact: David Crawford, Public Affairs and
Media Relations, The Ohio
State University
Wexner Medical
Center, 614-293-3737, or Crawford.1@osu.edu
