Association between inpatient AUDIT-C alcohol screening scores and postoperative outcomes: a retrospective cohort study.

objectivesTo evaluate whether alcohol use severity, as measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), is associated with postoperative complications, hospital utilisation and opioid prescribing among adult surgical inpatients.

designRetrospective cohort study.

settingSingle tertiary academic hospital in the USA, using data from inpatient surgical admissions between April 2021 and September 2023.

participantsAdult patients (≥18 years) admitted for inpatient surgery with a completed AUDIT-C screening during their admission. MEASURES: AUDIT-C scores were categorised as at-risk (≥5 for men, ≥4 for women) or low risk (other non-zero scores). Patients with AUDIT-C scores of 0 were described in the cohort but excluded from the primary comparative analyses to account for potential J-shaped associations between abstinence and health outcomes. The primary outcome was a composite of surgical complications, emergency department visits, hospital readmissions or mortality within 30 days of surgery. Secondary outcomes included hospital length of stay and postoperative opioid prescribing from discharge through 6 months. Univariable and multivariable logistic regression models were used to evaluate associations between AUDIT-C scores and postoperative outcomes. Additional analyses included Kaplan-Meier survival analysis, receiver operating characteristic curves and feature importance modelling.

results9538 (31.1%) of 30 708 eligible surgical patients completed the AUDIT-C, and screening was more common among younger, healthier patients. Among screened patients, 5440 (57.0%) were female and 7405 (77.6%) identified as non-Hispanic White. A total of 805 (8.4%) of screened patients reported at-risk alcohol use. The primary outcome, composite adverse postoperative outcomes, occurred in 13.9% of low-risk patients and 14.5% of at-risk patients (p=0.637). In unadjusted analyses, no significant differences were observed between alcohol risk groups for individual postoperative outcomes, including complications, 30-day readmissions, emergency department visits or mortality. Multivariable logistic regression confirmed no association between AUDIT-C category and the primary composite outcome (average marginal effect 0.01, 95% CI -0.02 to 0.03). Median hospital length of stay differed slightly between groups (3.0 days (IQR 4.0) vs 3.0 days (IQR 5.0); p=0.01). In adjusted Cox proportional hazards modelling, at-risk alcohol use was associated with a slightly lower hazard of discharge compared with low-risk alcohol use, corresponding to a modestly longer time to discharge (HR=0.92, p=0.041). Time to readmission did not differ significantly. Opioid prescribing at discharge was similar across groups (58.4% vs 58.9%, p=0.763).

conclusionsIn this real-world surgical cohort, observed AUDIT-C risk category among patients who completed screening was not significantly associated with short-term postoperative outcomes or opioid prescribing. While small differences in length of stay reached statistical significance, their clinical relevance is uncertain. Limitations include limited number of at-risk patients, non-response bias and the absence of standardised follow-up for at-risk patients, which may have contributed to null findings. Future efforts should focus on improving screening through workflow integration, surgical team engagement and follow-up interventions to fully realise benefits from alcohol screening.