Initiation of substance use-related treatments in surgical patients with risky alcohol use

OBJECTIVE: Alcohol use is a frequent and modifiable risk factor in surgical patients, yet it is rarely addressed. Our objective was to quantify receipt of interventions likely targeting unhealthy alcohol use in at-risk patients who were not receiving treatment before surgery. METHODS: Electronic health record data for surgical patients identified by preoperative Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) scores from September 1, 2011, to January 15, 2025, across a quaternary health system were extracted. The association between psychotherapy or pharmacotherapy treatment or referral in surgical patients at risk for alcohol use disorder without treatment in the 90 days before surgery and categorical AUDIT-C risk level was estimated using multivariable logistic regression. RESULTS: 18,887 surgical encounters in which the patient had not received recent substance use-related treatment were included in the study. Among these encounters, 22.4% involved documented behavioral or pharmacologic treatment or referral during the stay or within 90 days after discharge. Patients with high or severe risk AUDIT-C had increased odds of documentation of new psychotherapy or pharmacotherapy treatment or referral compared to those with moderate risk scores (high risk: aOR 1.44, 95% CI 1.25-1.65, p < 0.001; severe risk: aOR 2.04, 95% CI 1.80-2.31, p < 0.001). CONCLUSIONS: Although surgical patients with high or severe risk alcohol use were more likely to receive perioperative treatment or referrals than moderate-risk peers, overall rates of treatment initiation remained low. Addressing perioperative alcohol use in surgical patients requires concerted prioritization across clinical practices, health systems, and healthcare payors.