Cooley Samantha, Bicket Mark C, Mohammed Hanan, Lai Yenling, Evilsizer Sarah, Brummett Chad M, Waljee Jennifer F
Kansas City University, Kansas City, MO 64106, United States.
Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States.
Ann Surg. 2024 May 29. doi: 10.1097/SLA.0000000000006358.
We sought to compare identification of unhealthy substance use before surgery using The Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS), a standardized 4-item instrument, versus routine clinical documentation in the electronic medical record (EHR).
Over 20% of individuals exhibit unhealthy substance use before elective surgery. Routine EHR documentation is often based on non-standard questions that may not fully capture the extent of substance use and is subject to bias. In contrast, brief standardized screening could provide a more efficient and systematic approach.
We conducted a cross-sectional study among adults (≥18 y) at a preoperative clinic from August to September, 2021. Positive screens for unhealthy substances by TAPS were compared to data from the EHR. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were reported. Receiver operating characteristic curves (ROCs) were used to assess diagnostic ability. Multivariable logistic regression was used to estimate the predictors of positive screens by TAPS.
The cohort included 240 surgical patients. TAPS screening identified significantly more positive screens than EHR documentation (43.3% vs. 14.2%). Patients with unhealthy substance use were younger (50.8 vs. 56.7 y; P=0.003), and TAPS revealed alcohol misuse in 30.8% of cases, contrasting with 0% in clinician documentation (P<0.001). Of the 104 TAPS-positive patients, 69.2% were missed by EHR documentation. Sensitivity (31%) and accuracy (AUC=0.65) of clinician documentation for any unhealthy substance use were lower compared to TAPS.
Standardized TAPS screening detected preoperative unhealthy substance use more frequently than routine clinician documentation, emphasizing the need for integrating standardized measures into surgical practice to ensure safer perioperative care and outcomes.
我们试图比较使用标准化的4项工具“烟草、酒精、处方药和其他物质使用情况（TAPS）”与电子病历（EHR）中的常规临床记录来识别手术前不健康物质使用情况。
超过20%的个体在择期手术前存在不健康物质使用情况。常规电子病历记录通常基于非标准问题，可能无法完全捕捉物质使用的程度，且容易产生偏差。相比之下，简短的标准化筛查可以提供一种更有效、更系统的方法。
我们于2021年8月至9月在一家术前诊所对成年人（≥18岁）进行了一项横断面研究。将TAPS对不健康物质的阳性筛查结果与电子病历数据进行比较。报告了敏感性、特异性、阳性预测值、阴性预测值和准确性。使用受试者工作特征曲线（ROC）来评估诊断能力。采用多变量逻辑回归来估计TAPS阳性筛查的预测因素。
该队列包括240名手术患者。TAPS筛查发现的阳性筛查结果显著多于电子病历记录（43.3%对14.2%）。存在不健康物质使用情况的患者更年轻（50.8岁对56.7岁；P = 0.003），TAPS显示30.8%的病例存在酒精滥用，而临床医生记录中这一比例为0%（P < 0.001）。在104名TAPS阳性患者中，69.2%被电子病历记录遗漏。与TAPS相比，临床医生记录对任何不健康物质使用情况的敏感性（31%）和准确性（AUC = 0.65）较低。
标准化的TAPS筛查比常规临床医生记录更频繁地检测出术前不健康物质使用情况，强调了将标准化措施纳入手术实践以确保更安全的围手术期护理和结果的必要性。
