AUDIT-C Alcohol Screening Results and Postoperative Inpatient Health Care Use Anna D Rubinsky, MS, Haili Sun, PhD, David K Blough, PhD, Charles Maynard, PhD, Christopher L Bryson, MD, MS, Alex H Harris, PhD, Eric J Hawkins, PhD, Lauren A Beste, MD, MS, William G Henderson, PhD, Mary T Hawn, MD, MPH, FACS, Grant Hughes, BS, Michael J Bishop, MD, Ruth Etzioni, PhD, Hanne Tønnesen, MD, DMSC, Daniel R Kivlahan, PhD, Katharine A Bradley, MD, MPH BACKGROUND: Alcohol screening scores 5 on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) up to a year before surgery have been associated with postoperative complications, but the association with postoperative health care use is unknown. This study evaluated whether AUDIT-C scores in the year before surgery were associated with postoperative hospital length of stay, total ICU days, return to the operating room, and hospital readmission. STUDY DESIGN: This cohort study included male Veterans Affairs patients who completed the AUDIT-C on mailed surveys (October 2003 through September 2006) and were hospitalized for nonemer- gent noncardiac major operations in the following year. Postoperative health care use was evaluated across 4 AUDIT-C risk groups (scores 0, 1 to 4, 5 to 8, and 9 to 12) using linear or logistic regression models adjusted for sociodemographics, smoking status, surgical category, relative value unit, and time from AUDIT-C to surgery. Patients with AUDIT-C scores indi- cating low-risk drinking (scores 1 to 4) were the referent group. RESULTS: Adjusted analyses revealed that among eligible surgical patients (n = 5,171), those with the highest AUDIT-C scores (ie, 9 to 12) had longer postoperative hospital length of stay (5.8 [95% CI, 5.0-6.7] vs 5.0 [95% CI, 4.7-5.3] days), more ICU days (4.5 [95% CI, 3.2-5.8] vs 2.8 [95% CI, 2.6-3.1] days), and increased probability of return to the operating room (10% [95% CI, 6-13%] vs 5% [95% CI, 4-6%]) in the 30 days after surgery, but not increased hospital readmission within 30 days postdischarge, relative to the low-risk group. CONCLUSIONS: AUDIT-C screening results could be used to identify patients at risk for increased postoperative health care use who might benefit from preoperative alcohol interventions. (J Am Coll Surg 2012;214:296–305. © 2012 by the American College of Surgeons) Disclosure Information: Nothing to disclose. The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Develop- ment and Health Services Research and Development (IAC 06-021). Ms Rubinsky was also supported by an Agency for Healthcare Research and Quality Institutional National Research Service Award through the Univer- sity of Washington (T32 HS 013853) when this work was conducted. The views expressed in this article are those of the authors and do not neces- sarily reflect the position or policy of the Department of Veterans Affairs. Abstract presented at the Addiction Health Services Research Annual Meet- ing in San Francisco, CA, October 2009, and at the AcademyHealth Annual Research Meeting and National Research Service Award Trainees Research Conference, Seattle, WA, June 2011. Received July 20, 2011; Revised November 18, 2011; Accepted November 21, 2011. From Health Services Research and Development (Rubinsky, Sun, Blough, Maynard, Bryson, Hawkins, Kivlahan, Bradley), General Medi- cine Service (Bryson, Beste, Bradley), and Center of Excellence in Sub- stance Abuse Treatment and Education (Hawkins, Kivlahan, Bradley), Department of Veterans Affairs Puget Sound Health Care System, De- partments of Health Services (Rubinsky, Maynard, Etzioni, Bradley), Pharmacy (Blough), Psychiatry and Behavioral Sciences (Hawkins, Kivla- han), Anesthesiology (Bishop), Biostatistics (Etzioni), and Medicine (Brad- ley), University of Washington; Fred Hutchinson Cancer Research Center (Etzioni); Group Health Research Institute (Bradley), Seattle, WA; Center for Health Care Evaluation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA (Harris); Department of Veterans Affairs East- ern Colorado Healthcare System, Denver (Henderson, Hughes); University of Colorado Health Outcomes Program, Aurora (Henderson), CO; Center for Surgical, Medical, Acute care Research and Transitions (C-SMART), Bir- mingham Veterans Affairs Medical Center (Hawn); Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Hawn); and WHO Collaborating Centre for Evidence-Based Health Promotion in Hospitals and Health Services, Bispebjerg University Hospital, Copenhagen, Denmark (Tønnesen). Correspondence address: Anna D Rubinsky, MS, Health Services Re- search and Development, VA Puget Sound Health Care System, 1660 South Columbian Way (S-152), Seattle, WA 98108. email: Anna.Rubinsky@ va.gov 296 © 2012 by the American College of Surgeons ISSN 1072-7515/12/$36.00 Published by Elsevier Inc. doi:10.1016/j.jamcollsurg.2011.11.007