Budworth Luke, Prestwich Andrew, Lawton Rebecca, Kotzé Alwyn, Kellar Ian
School of Psychology, University of Leeds, Leeds, United Kingdom.
Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom.
Front Psychol. 2019 Feb 4;10:34. doi: 10.3389/fpsyg.2019.00034. eCollection 2019.
Preoperative alcohol and other recreational substance use (ORSU) may catalyze perioperative complications. Accordingly, interventions aiming to reduce preoperative substance use are warranted. Studies investigating interventions to reduce alcohol and/or ORSU in elective surgery patients were identified from: Cochrane Library; MEDLINE; PSYCINFO; EMBASE; and CINAHL. In both narrative summaries of results and random effects meta-analyses, effects of interventions on perioperative alcohol/ORSU, complications, mortality and length of stay were assessed. Nine studies ( = 903) were included. Seven used behavioral interventions only, two provided disulfiram in addition. Pooled analyses found small effects on alcohol use (: 0.34; 0.05-0.64), though two trials using disulfiram (0.71; 0.36-1.07) were superior to two using behavioral interventions (0.45; -0.49-1.39). No significant pooled effects were found for perioperative complications, length of hospital stay or mortality in studies solely targeting alcohol/ORSU. Too few interventions targeting ORSU ( = 1) were located to form conclusions regarding their efficacy. Studies were generally at high risk-of-bias and heterogeneous. Preoperative interventions were beneficial in reducing substance use in some instances, but more high-quality studies targeting alcohol/ORSU specifically are needed. The literature to date does not suggest that such interventions can reduce postoperative morbidity, length of hospital stay or mortality. Limitations in the literature are outlined and recommendations for future studies are suggested.
术前饮酒及使用其他消遣性物质（ORSU）可能会引发围手术期并发症。因此，有必要采取干预措施以减少术前物质使用。我们从Cochrane图书馆、MEDLINE、PSYCINFO、EMBASE和CINAHL中检索了调查针对择期手术患者减少酒精和/或ORSU干预措施的研究。在结果的叙述性总结和随机效应荟萃分析中，评估了干预措施对围手术期酒精/ORSU、并发症、死亡率和住院时间的影响。共纳入9项研究（n = 903）。7项仅使用行为干预措施，2项还提供了双硫仑。汇总分析发现，干预措施对酒精使用有较小影响（SMD：0.34；95%CI：0.05 - 0.64），不过两项使用双硫仑的试验（SMD：0.71；95%CI：0.36 - 1.07）优于两项使用行为干预措施的试验（SMD：0.45；95%CI：-0.49 - 1.39）。在仅针对酒精/ORSU的研究中，未发现围手术期并发症、住院时间或死亡率有显著的汇总效应。针对ORSU的干预措施（n = 1）数量太少，无法就其疗效得出结论。研究总体存在较高的偏倚风险且异质性较大。术前干预措施在某些情况下有助于减少物质使用，但需要更多专门针对酒精/ORSU的高质量研究。迄今为止的文献并未表明此类干预措施可降低术后发病率、住院时间或死亡率。文中概述了文献的局限性，并对未来研究提出了建议。
