Bridging the Gap: Implementation and Uptake of AUDIT-C Alcohol Screening for Inpatient Surgery.

[OBJECTIVE] To evaluate the feasibility of Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening among surgical inpatients following hospital-wide implementation of a quality improvement initiative.

[BACKGROUND] Risky alcohol use increases postoperative complications, yet alcohol screening for surgery remains inconsistently applied. As a brief, validated screening tool, the AUDIT-C may improve risk assessment and guide timely intervention, but its adoption in surgical settings is understudied.

[METHODS] We retrospectively analyzed electronic health record data from inpatient surgical admissions between April 2021 and September 2023. The primary outcome was completion of a valid AUDIT-C score during admission. Scores were categorized as no use (0), low-risk (1-4), moderate-risk (5-8), and high-risk (9-12). Multivariable logistic regression assessed independent associations with AUDIT-C screening completion.

[RESULTS] Among 30,714 encounters, 9540 (31.1%) had a completed AUDIT-C score. Screening completion varied by surgical service (15.2%-52.4%) and was higher in emergent (51.7%) and urgent (48.4%) cases than elective (29.1%) cases. The 3 most frequently performed procedures screened 53.8% (cesarean), 42.8% (free flap), and 11.6% (aortic valve) of patients. In multivariable models, emergent case status [marginal effect (ME): 0.14], urgent case status (ME: 0.09), and Medicare insurance (ME: 0.03) were independently associated with higher odds of screening completion. Among those screened, 6.5% were classified as moderate- or high-risk.

[CONCLUSIONS] Perioperative alcohol screening using AUDIT-C is feasible but inconsistently implemented. System-wide integration could support identification of at-risk patients and improve perioperative outcomes.