Alcohol Abuse Increases Surgical Risks

The more people drink before having a hip or knee replaced, the higher their risk for complications right after the surgery, a new study suggests.

Doctors have long suspected that excessive drinkers have more problems after surgery, but "this is the first study that really shows, with data and statistics," that it's true, said Dr. Nicholas Giori, from Stanford University, Palo Alto, California, who presented the results last week at the 2011 Annual Meeting of the American Academy of Orthopedic Surgeons in San Diego.

Giori and his colleague Dr. Alex Harris looked at surgical complication rates in 185 men who had hip and knee replacement surgery at the Palo Alto Veterans Affairs Hospital.

They found that men who admitted alcohol abuse at their annual check-up were more likely to have complications in the period right after their surgery compared to men who said they didn't drink too much.

Complications included pneumonia, delirium, stroke, life-threatening infections, blood clots in the lungs and in major blood vessels, gastrointestinal bleeding, major infections of the surgery site, serious heart rhythm abnormalities, urinary tract infection, and shock.

Every year at their annual check-up, VA patients answer questions on the Alcohol Use Disorders Identification Test (AUDIT-C). Each man in the study had reported at least some drinking in the past year.

Alcohol misuse, as defined by the AUDIT-C test, includes drinking more than four times a week, having more than nine drinks in a typical day, or regularly having more than six drinks a day.

After taking patients' age and other illnesses into account, each additional point on the 12-point scale corresponded to a 29 percent increase in the average number of complications.

The next step would be to see whether screening for drinking problems and trying to treat them before the surgery would help lower the complication risk, Giori said.

"We could intervene in anyone who tests over 5 and try to have them reduce their drinking for a month or so before surgery and see what happens," he said.

"We might really scare some people into stopping because I certainly do find that during the perioperative period people start to get serious about their medical care," Giori added. "If I have a serious conversation with them about their risks and behaviors, most people will listen and it is actually a good time to intervene."