Department of Anaesthesiology and Operative Intensive Medicine, Charité Universitätsmedizin, Berlin, Germany.
Minerva Anestesiol. 2010 Jan;76(1):29-37. Epub 2009 Nov 24.
Illicit substance use (ISU) is a worldwide burden, and its prevalence in surgical patients has not been well investigated. Co-consumption of legal substances, such as alcohol and tobacco, complicates the perioperative management and is frequently underestimated during routine preoperative assessment. The aim of this study was to compare the anesthesiologists' detection rate of ISU during routine preoperative assessment with a computerized self-assessment questionnaire.
In total, 2,938 patients were included in this study. Prior to preoperative assessment, patients were asked to complete a computer-based questionnaire that addressed ISU, alcohol use disorder (AUDIT), nicotine use (Fagerström) and socio-economic variables (education, income, employment, partnership and size of household). Medical records were reviewed, and the anesthesiologists' detection of ISU was compared to the patients' self-reported ISU.
Seven point five percent of patients reported ISU within the previous twelve months. ISU was highest in the age group between 18 and 30 years (26.4%; P<0.01). Patients reporting ISU were more often men than women (P<0.01), smokers (P<0.01) and tested positive for alcohol use disorder (P<0.01). Anesthesiologists detected ISU in one in 43 patients, whereas the computerized self-assessment reported it in one in 13 patients. The detection was best in the subgroup self-reporting frequent ISU (P<0.01).
Anesthesiologists underestimate the prevalence of ISU. Computer-based self-assessment increases the detection of ISU in preoperative assessment and may decrease perioperative risk. More strategies to improve the detection of ISU as well as brief interventions for ISU are required in preoperative assessment clinics.
非法物质使用（ISU）是一个全球性的负担，其在手术患者中的流行情况尚未得到充分研究。合法物质（如酒精和烟草）的共同使用使围手术期管理变得复杂，并且在常规术前评估中经常被低估。本研究的目的是比较麻醉师在常规术前评估中检测 ISU 的发生率与计算机化自我评估问卷。
共有 2938 名患者纳入本研究。在术前评估之前，患者被要求完成一份基于计算机的问卷，该问卷涉及 ISU、酒精使用障碍（AUDIT）、尼古丁使用（Fagerström）和社会经济变量（教育、收入、就业、伴侣关系和家庭规模）。审查病历，并将麻醉师对 ISU 的检测结果与患者自我报告的 ISU 进行比较。
7.5%的患者报告在过去 12 个月内有 ISU。年龄在 18 至 30 岁之间的患者 ISU 发生率最高（26.4%；P<0.01）。报告有 ISU 的患者中男性多于女性（P<0.01），吸烟者（P<0.01），酒精使用障碍检测呈阳性（P<0.01）。麻醉师在每 43 名患者中发现 1 例 ISU，而计算机化自我评估报告每 13 名患者中有 1 例 ISU。在自我报告频繁 ISU 的亚组中，检测效果最好（P<0.01）。
麻醉师低估了 ISU 的流行率。基于计算机的自我评估增加了术前评估中 ISU 的检出率，并可能降低围手术期风险。需要在术前评估诊所中采取更多策略来提高 ISU 的检出率，并对 ISU 进行简短干预。
