Preoperative alcohol interventions for elective surgical patients: Results from a randomized pilot trial

Published:October 22, 2022DOI:



      High-risk alcohol use is a common surgical risk factor. Stopping or reducing alcohol use in the weeks before and after surgery could improve surgical health and outcomes. The purpose of this study was to evaluate the feasibility and acceptability of 2 interventions that address high-risk alcohol use in the context of surgery.


      Participants included patients scheduled for elective surgeries at an academic health system in the Midwestern United States. Recruitment took place by phone and text. Participants were included if they were 18 to 75 years old, scheduled for elective surgeries, and scored ≥5 on the Alcohol Use Disorders Identification Test–Consumption Tool. Participants were randomized to either a low-intensity intervention, brief advice (10-minute phone-based psychoeducation plus feedback session), or a higher-intensity intervention, health coaching (two 45-minute sessions including education, feedback, motivational interviewing, and goal setting). Assessments took place at baseline and at 1-month and 4-month follow-ups. Alcohol biomarkers were collected the day of surgery.


      The final study sample included (n = 51) participants randomized to brief advice and health coaching conditions. Participants in both conditions rated interventions as satisfactory and personally relevant. Trial retention was high (86.3%) at 4 months. Attrition was significantly higher in brief advice (n = 6) relative to health coaching (n = 1). Average weekly alcohol use decreased 50% to 60% between baseline and follow-ups in both conditions. Biomarkers corroborated self-report.


      The trial demonstrated intervention feasibility and acceptability. Alcohol use changed in expected directions. The next steps include a randomized controlled trial to test intervention efficacy in reducing alcohol use and surgical complications.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Harris A.H.S.
        • Frey M.S.
        • Debenedetti A.F.
        • Bradley K.A.
        Alcohol misuse prevalence and associations with post-operative complications in US surgical patients: a review.
        Open J Surg. 2008; : 50-58
        • Rubinsky A.D.
        • Bishop M.J.
        • Maynard C.
        • et al.
        Postoperative risks associated with alcohol screening depend on documented drinking at the time of surgery.
        Drug Alcohol Depend. 2013; 132: 521-527
        • Bradley K.A.
        • Rubinsky A.D.
        • Sun H.
        • et al.
        Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery.
        J Gen Intern Med. 2011; 26: 162-169
        • Khuri S.F.
        • Henderson W.G.
        • Daley J.
        • et al.
        Successful implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the private sector: the Patient Safety in Surgery study.
        Ann Surg. 2008; 248: 329-336
        • Harris A.H.
        • Reeder R.
        • Ellerbe L.
        • Bradley K.A.
        • Rubinsky A.D.
        • Giori N.J.
        Preoperative alcohol screening scores: association with complications in men undergoing total joint arthroplasty.
        J Bone Joint Surg Am. 2011; 93: 321-327
        • Eliasen M.
        • Grønkjær M.
        • Skov-Ettrup L.S.
        • et al.
        Preoperative alcohol consumption and postoperative complications: a systematic review and meta-analysis.
        Ann Surg. 2013; 258
        • Tonnesen H.
        • Petersen K.R.
        • Hojgaard L.
        • et al.
        Postoperative morbidity among symptom-free alcohol misusers.
        Lancet. 1992; 340: 334-337
        • Delgado-Rodriguez M.
        • Gomez-Ortega A.
        • Mariscal-Ortiz M.
        • Palma-Perez S.
        • Sillero-Arenas M.
        Alcohol drinking as a predictor of intensive care and hospital mortality in general surgery: a prospective study.
        Addiction. 2003; 98: 611-616
      1. American Society of Anesthesiologists. ASA Physical Status Classification System. 2014.

        • American College of Surgeons
        Strong for surgery.
        • Aarvold A.
        • Crofts T.
        Missed opportunities? Management of patients with alcohol problems in a surgical ward.
        Health Bull (Raleigh). 2002; 60: 55-61
        • Tonnesen H.
        • Faurschou P.
        • Ralov H.
        • Molgaard-Nielsen D.
        • Thomas G.
        • Backer V.
        Risk reduction before surgery: the role of the primary care provider in preoperative smoking and alcohol cessation.
        BMC Health Serv Res. 2010; 10: 121
        • Fernandez A.C.
        • Claborn K.R.
        • Borsari B.
        A systematic review of behavioural interventions to reduce preoperative alcohol use.
        Drug Alcohol Rev. 2015; 34: 508-520
        • Egholm J.W.
        • Pedersen B.
        • Møller A.M.
        • Adami J.
        • Juhl C.B.
        • Tønnesen H.
        Perioperative alcohol cessation intervention for postoperative complications.
        Cochrane Database Syst Rev. 2018; 11
        • Tønnesen H.
        • Egholm J.W.
        • Oppedal K.
        • Lauritzen J.B.
        • Madsen B.L.
        • Pedersen B.
        Patient education for alcohol cessation intervention at the time of acute fracture surgery: study protocol for a randomised clinical multi-centre trial on a gold standard programme (Scand-Ankle).
        BMC Surg. 2015; 15: 52
        • Oppedal K.
        • Møller A.
        • Pedersen B.
        • Tønnesen H.
        Preoperative alcohol cessation prior to elective surgery.
        Cochrane Database Syst Rev. 2012; : CD008343
        • Fuller R.K.
        • Branchey L.
        • Brightwell D.R.
        • et al.
        Disulfiram treatment of alcoholism: a Veterans Administration cooperative study.
        JAMA. 1986; 256: 1449-1455
        • Vahr Lauridsen S.
        • Thomsen T.
        • Thind P.
        • Tønnesen H.
        STOP smoking and alcohol drinking before OPeration for bladder cancer (the STOP-OP study), perioperative smoking and alcohol cessation intervention in relation to radical cystectomy: study protocol for a randomised controlled trial.
        • Shourie S.
        • Conigrave K.M.
        • Proude E.M.
        • Ward J.E.
        • Wutzke S.E.
        • Haber P.S.
        The effectiveness of a tailored intervention for excessive alcohol consumption prior to elective surgery.
        Alcohol Alcohol. 2006; 41: 643-649
        • Fernandez A.C.
        • Guetterman T.C.
        • Borsari B.
        • et al.
        Gaps in alcohol screening and intervention practices in surgical healthcare: a qualitative study.
        J Addict Med. 2020; 15: 113-119
        • Englesbe M.J.
        • Grenda D.R.
        • Sullivan J.A.
        • et al.
        The Michigan Surgical Home and Optimization Program is a scalable model to improve care and reduce costs.
        Surgery. 2017; 161: 1659-1666
        • Englesbe M.J.
        • Lussiez A.D.
        • Friedman J.F.
        • Sullivan J.A.
        • Wang S.C.
        Starting a surgical home.
        Ann Surg. 2015; 262: 901-903
        • Almirall D.
        • Compton S.N.
        • Gunlicks-Stoessel M.
        • Duan N.
        • Murphy S.A.
        Designing a pilot sequential multiple assignment randomized trial for developing an adaptive treatment strategy.
        Stat Med. 2012; 31: 1887-1902
        • Snowden C.
        • Lynch E.
        • Avery L.
        • et al.
        Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT.
        Health Technol Assess. 2020; 24: 1
        • Bradley K.A.
        • Rubinsky A.D.
        • Sun H.
        • et al.
        Prevalence of alcohol misuse among men and women undergoing major noncardiac surgery in the Veterans Affairs health care system.
        Surgery. 2012; 152: 69-81
        • Rubinsky A.D.
        • Sun H.
        • Blough D.K.
        AUDIT-C alcohol screening results and postoperative inpatient health care use.
        J Am Coll Surg. 2012; 214 (al.): 296-305.e1
        • Miller W.R.
        • Rollnick S.
        Motivational Interviewing: Preparing People for Change.
        2nd ed. Guilford, New York2002
        • Glanz K.
        • Bishop D.B.
        The role of behavioral science theory in development and implementation of public health interventions.
        Ann Rev Public Health. 2010; 31: 399-418
        • Janz N.K.
        • Becker M.H.
        The health belief model: a decade later.
        Heal Educ Behav. 1984; 11: 1-47
        • Moyers T.B.
        • Rowell L.N.
        • Manuel J.K.
        • Ernst D.
        • Houck J.M.
        The Motivational Interviewing Treatment Integrity Code (MITI 4): rationale, preliminary reliability and validity.
        J Subst Abuse Treat. 2016; 65: 36
        • Hallgren K.A.
        Computing inter-rater reliability for observational data: an overview and tutorial.
        Tutor Quant Methods Psychol. 2012; 8: 23
        • Bush K.
        • Kivlahan D.R.
        • McDonell M.B.
        • Fihn S.D.
        • Bradley K.A.
        The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking.
        Arch Intern Med. 1998; 158: 1789-1795
        • Sobell L.C.
        • Sobell M.B.
        Timeline follow-back.
        in: Litten R.Z. Allen J.P. Measuring Alcohol Consumption: Psychosocial and Biochemical Methods. Humana Press, Totowa, NJ1992: 41-72
        • Schrock A.
        • Thierauf-Emberger A.
        • Schurch S.
        • Weinmann W.
        Phosphatidylethanol (PEth) detected in blood for 3 to 12 days after single consumption of alcohol-a drinking study with 16 volunteers.
        Int J Legal Med. 2017; 131: 153-160
        • Afshar M.
        • Burnham E.L.
        • Joyce C.
        • et al.
        Cut-point levels of phosphatidylethanol to identify alcohol misuse in a mixed cohort including critically ill patients.
        Alcohol Clin Exp Res. 2017; 41: 1745-1753
        • Cherrier M.M.
        • Shireman L.M.
        • Wicklander K.
        • et al.
        Relationship of phosphatidylethanol biomarker to self-reported alcohol drinking patterns in older and middle-age adults.
        Alcohol Clin Exp Res. 2020; 44: 2449-2456
        • Litten R.Z.
        • Bradley A.M.
        • Moss H.B.
        Alcohol biomarkers in applied settings: recent advances and future research opportunities.
        Alcohol Clin Exp Res. 2010; 34: 955-967
        • Michigan Surgical Quality Collaborative
        Clinical data abstraction.
        • Kroenke K.
        • Yu Z.
        • Wu J.
        • Kean J.
        • Monahan P.O.
        Operating characteristics of PROMIS four-item depression and anxiety scales in primary care patients with chronic pain.
        Pain Med. 2014; 15: 1892-1901
        • Fernandez A.C.
        • Waller R.
        • Walton M.A.
        • et al.
        Alcohol use severity and age moderate the effects of brief interventions in an emergency department randomized controlled trial.
        Drug Alcohol Depend. 2019; 194: 386-394
        • Tonnesen H.
        • Nielsen P.R.
        • Lauritzen J.B.
        • Moller A.M.
        Smoking and alcohol intervention before surgery: evidence for best practice.
        Br J Anaesth. 2009; 102: 297-306
        • Del Boca F.K.
        • Darkes J.
        The validity of self-reports of alcohol consumption: state of the science and challenges for research.
        Addiction. 2003; 98: 1-12
        • Nielsen D.G.
        • Andersen K.
        • Nielsen A.S.
        • Juhl C.
        • Mellentin A.
        Consistency between self-reported alcohol consumption and biological markers among patients with alcohol use disorder: a systematic review.
        Neurosci Biobehav Rev. 2021; 124: 370-385
        • Pedersen B.
        • Alva-Jørgensen P.
        • Raffing R.
        • Tønnesen H.
        Fractures and alcohol abuse: patient opinion of alcohol intervention.
        Open Orthop J. 2011; 5: 7-12
        • Lauridsen S.V.
        • Thomsen T.
        • Kaldan G.
        • Lydom L.N.
        • Tønnesen H.
        Smoking and alcohol cessation intervention in relation to radical cystectomy: a qualitative study of cancer patients’ experiences.
        BMC Cancer. 2017; 17: 793
        • Lin L.A.
        • Fernandez A.C.
        • Bonar E.E.
        Telehealth for substance-using populations in the age of coronavirus disease 2019: recommendations to enhance adoption.
        JAMA Psychiatry. 2020; 77: 1209-1210
        • Murphy S.A.
        • Lynch K.G.
        • Oslin D.
        • McKay J.R.
        • TenHave T.
        Developing adaptive treatment strategies in substance abuse research.
        Drug and Alcohol Dependence. 2007; 88: S24-S30
        • Collins L.M.
        • Murphy S.A.
        • Strecher V.
        The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions.
        Am J Prev Med. 2007; 32: S112-S118