(145) Alcohol Screening During Surgical Hospitalization Expands Opportunity for Addiction Care

Background & Introduction: Risky alcohol use increases postoperative complications, yet alcohol screening during surgical hospitalization remains inconsistently implemented, particularly outside integrated systems. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a brief, validated screening tool that can identify unhealthy alcohol use and guide timely intervention, but its real-world uptake among inpatient surgical populations is poorly characterized. Preoperative screening may miss patients undergoing urgent or emergent surgery, while inpatient workflows face competing documentation demands. We evaluated a hospital-wide quality improvement initiative integrating AUDIT-C into electronic health record admission workflows to assess feasibility and variability of screening completion among surgical inpatients.

Methods: We conducted a retrospective cohort study using electronic health record data from adult inpatient surgical admissions at a tertiary academic health system (April 2021-September 2023). Admissions were included if surgery and admission occurred on the same day; encounters < 24 hours were excluded. The primary outcome was completion of a valid AUDIT-C score during admission. AUDIT-C scores were categorized as no use (0), low-risk (1-4), moderate-risk (5-8), or high-risk (9-12). Screening completion was summarized across patient demographics and surgical care characteristics. Standardized mean differences assessed imbalance, and multivariable logistic regression identified factors independently associated with screening completion, reported as marginal effects. The study was deemed exempt as evaluation of routine clinical care.

Results: AUDIT-C Screening Completion
Among 30,714 inpatient surgical admissions, 9,540 (31.1%) had a completed Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) score. Completion was higher among patients admitted for urgent and emergent surgery compared with elective surgery (48.4% and 51.7% vs 29.1%) and varied widely across surgical services and hospital sites. In adjusted analyses, emergent case status (marginal effect [ME] +0.14), urgent case status (ME +0.09), Medicare insurance (ME +0.03), and surgical service were independently associated with screening completion; age, sex, race/ethnicity, and American Society of Anesthesiologists (ASA) class were not.

Variation by Surgical Characteristics
Screening completion ranged from 15.0% to 52.4% by surgical service, with lower rates in cardiac, thoracic, vascular, and internal medicine-affiliated surgical admissions and higher rates in obstetrics and gynecology, ophthalmology, and acute care surgery. Completion declined with increasing comorbidity burden and varied by anesthesia technique.
Alcohol Use Risk Among Screened Patients.
Among patients with completed screening, 38.4% reported any alcohol use, including 31.9% classified as low-risk and 6.5% classified as moderate- or high-risk alcohol use.

Conclusion & Discussion: In this large, real-world evaluation of alcohol screening during surgical hospitalization, AUDIT-C completion was documented for approximately one-third of surgical admissions following hospital-wide electronic health record integration. Screening uptake varied substantially across surgical services, hospital sites, and clinical contexts, indicating that feasibility does not ensure consistent implementation. Higher completion in urgent and emergent cases demonstrates that inpatient admission workflows can support alcohol screening when preoperative assessment is not feasible. Among screened patients, a meaningful proportion met criteria for moderate- or high-risk alcohol use, underscoring surgical hospitalization as an important opportunity for identifying unhealthy alcohol use and initiating addiction-focused evaluation or referral. Together, these findings support AUDIT-C as a feasible inpatient screening tool and highlight the need for standardized workflows and stronger integration with addiction medicine pathways to ensure equitable identification and linkage to evidence-based care.

References: • Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998;158(16):1789–1795.
• Bradley KA, Rubinsky AD, Sun H, et al. Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery. J Gen Intern Med. 2011;26(2):162–169.
• Rubinsky AD, Sun H, Blough DK, et al. AUDIT-C alcohol screening results and postoperative inpatient health care use. J Am Coll Surg. 2012;214(3):296–305.e1.
• Eliasen M, Grønkjær M, Skov-Ettrup LS, et al. Preoperative alcohol consumption and postoperative complications: systematic review and meta-analysis. Ann Surg. 2013;258(6):930–942.
• Tønnesen H, Nielsen PR, Lauritzen JB, Møller AM. Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anaesth. 2009;102(3):297–306.