Department of Psychiatry, University of Michigan, Ann Arbor, MI (ACF, AH, FCB); Department of Family Medicine, University of Michigan, Ann Arbor, MI (TCG); Mental Health Service, San Francisco VA Health Care System, San Francisco, CA (BB); Department of Psychiatry, University of California, San Francisco, 982 Mission St, San Francisco, CA 94103 (BB); Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI (MJM); Department of Health Services, Practice and Policy, Brown University School of Public Health, Providence, RI (MJM); Department of Gastroenterology, University of Michigan, Ann Arbor, MI (JM); Clinical Health Promotion Centre, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (HT); Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI (AH, FCB); S-SPIRE Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA (AMM).
J Addict Med. 2021 Apr 1;15(2):113-119. doi: 10.1097/ADM.0000000000000706.
Risky alcohol use before surgery is associated with an increased risk of postoperative complications and longer hospital stays. Preoperative alcohol interventions can improve surgical outcomes but are not commonly integrated into routine care. This study sought to better understand patient's and provider's perceptions of alcohol-related surgical health and healthcare practices and illuminate gaps in care and how they could be improved.
This study used a descriptive qualitative research design. Data were collected between July 2017 and March 2018. One-on-one interviews assessed domains related to knowledge, gaps in alcohol-related screening and intervention, and interest in enhancing alcohol-related care. Key themes emerged from a process of iterative coding and thematic analysis.
Participants included elective surgical patients who met alcohol screening criteria (n = 20) and surgical healthcare providers (n = 9). Participants had modest or low awareness of alcohol-related surgical health risks. Basic alcohol screening was a routine part of care, but results were often discounted or overlooked. Providers did not routinely initiate preoperative alcohol education or intervention. Providers viewed improving alcohol-related clinical practices as a low priority. Patients were interested in receiving alcohol interventions before surgery if they were delivered in a nonjudgement style and focused on surgical health optimization.
This study highlights potential gaps in alcohol-related knowledge and care, and found providers place a low priority on alcohol interventions in the perioperative context. Given the high complication rate associated with preoperative alcohol use, these topics are worthy of future research. To be successful strategies to overcome specific barriers to alcohol screening and intervention must address the needs of patients and providers.
手术前的危险饮酒与术后并发症风险增加和住院时间延长有关。术前酒精干预可以改善手术结果，但通常不会纳入常规护理。本研究旨在更好地了解患者和提供者对与酒精相关的手术健康和医疗保健实践的看法，并阐明护理中的差距以及如何改进这些差距。
本研究采用描述性定性研究设计。数据收集于 2017 年 7 月至 2018 年 3 月之间进行。一对一访谈评估了与知识相关的领域，包括酒精相关筛查和干预方面的差距，以及增强与酒精相关的护理的兴趣。主题从迭代编码和主题分析的过程中浮现出来。
参与者包括符合酒精筛查标准的择期手术患者（n=20）和手术医疗保健提供者（n=9）。参与者对与酒精相关的手术健康风险的认识有限或较低。基本的酒精筛查是护理的常规部分，但结果通常被忽视或忽略。提供者通常不会主动进行术前酒精教育或干预。提供者认为改善与酒精相关的临床实践是低优先级。如果以非评判的方式提供并侧重于手术健康优化，患者对在手术前接受酒精干预有兴趣。
本研究强调了与酒精相关的知识和护理方面的潜在差距，并发现提供者在围手术期环境中对酒精干预的重视程度较低。鉴于术前饮酒与高并发症率相关，这些主题值得进一步研究。为了取得成功，克服酒精筛查和干预的具体障碍的策略必须满足患者和提供者的需求。
