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| |  Simple Tool Identifies Alcohol-Use Disorders in Surgical Patients PARK RIDGE, Ill -- July 23, 2008 -- Alcohol-use disorders (AUDs) are frequently overlooked in patients undergoing surgery, but a very simple and effective method identifies patients who may be at risk for alcohol-related perioperative complications, according to a study in the August 2008 issue of Anesthesiology. Claudia D. Spies, MD, Charité - Universitätsmedizin Berlin, Berlin, Germany, and colleagues 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 3 to 4 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 the Alcohol Use Disorder Identification Test (AUDIT). When AUDIT was used, over twice as many patients with AUD were identified compared with the standard preoperative interview. Part of AUDIT's success when compared with physicians' interviews alone may be due in part to physicians' lack of training in preoperative screening for alcohol use and also the more anonymous nature of the computerised test itself. "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. "Anesthesiologists can play an important role in preventing severe consequences of AUD and thereby contributing to an improvement in public health," said Dr. Spies. "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 behavior may become dangerous at some point in the future." The study found that an overwhelming majority of physicians neglected to use well-documented tools for AUD detection, perhaps because they were uncomfortable in questioning patients about alcohol consumption. "Physicians tend to underestimate and miss AUD in younger patients, especially young female patients," Dr. Spies said. "Our results emphasise 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, which 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. "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. SOURCE: American Society of Anesthesiologists
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