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Objective: To assess associations between co-occurring preoperative smoking and risky alcohol use on the likelihood of adverse surgical outcomes. Background: Risky alcohol use and smoking are the known surgical risk factors with a high co-occurrence and additive adverse effects on multiple organ systems that impact surgical health, yet no research has evaluated the impact of co-occurrence on surgical outcomes. Methods: This investigation analyzed 200,816 patients from the Michigan Surgical Quality Collaborative database between July 1, 2012, to December 31, 2018. Patients were classified based on past year risky alcohol use (>2 drink/day) and cigarette smoking into 4 groups: (1) risky alcohol and smoking, (2) risky alcohol only, (3) smoking only, and (4) no risky alcohol/smoking. We fitted logistic regression models, applying propensity score weights incorporating demographic, clinical, and surgical factors to assess associations between alcohol and smoking and 30-day postoperative outcomes; surgical complications, readmission, reoperation, and emergency department (ED) visits. Results: Risky alcohol and smoking, risky alcohol only, and smoking only were reported by 2852 (1.4%), 2840 (1.4%), and 44,042 (22%) patients, respectively. Relative to all other groups, the alcohol and smoking group had greater odds of surgical complications, readmission, and reoperation. Relative to the no alcohol and smoking group, the alcohol only group higher odds of reoperation and smoking only group had higher odds of emergency department visits. Conclusions: The combination of smoking and risky drinking conferred the highest likelihood of complications, readmission, and reoperation before surgery. Co-occurring alcohol and smoking at the time of surgery warrants special attention as a patient risk factor and deserves additional research. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a relatively prevalent and burdensome condition with significant public health cost; however, epidemiological studies of TBI in the United States have rarely used nationally representative samples or included measures of functioning. Data were obtained from the third wave of the National Epidemiological Survey on Alcohol and Related Conditions. Of the 36,309 individuals surveyed, 193 (0.53% weighted) reported a past-year TBI. Results from weighted logistic regression modeling indicated that prior active duty military status, mood disorders, posttraumatic stress disorder, and nicotine use disorders were associated with greater odds of TBI. Annual household income greater than $20,000 was associated with lower odds of TBI. Regarding functioning, TBI was associated with greater impairment on SF-12 scales measuring mental and physical health and the organization subscale of the Executive Function Index. Results suggest that many individuals in the US population experience TBI each year and that such injuries are associated with impairment across multiple domains. [ABSTRACT FROM AUTHOR]

Research published in the aftermath of the 9/11 terrorist attack reported elevated rates of posttraumatic stress disorder (PTSD) in the US population (4.3%-17.0%), attributable to indirect exposure through the media. We use data from a national survey conducted in 2004 to 2005 (National Epidemiologic Survey on Alcohol and Related Conditions Wave 2) (n = 34,653). The list of traumatic events covered in the survey included indirect exposure to 9/11 through media coverage. Respondents who endorsed more than 1 traumatic event were asked to single out "the worst event" they had ever experienced. The worst event (or the only event) was the index event for diagnosing PTSD. Indirect experience of 9/11 had the lowest PTSD risk of all the traumatic events in the list, 1.3%. In the subset that endorsed only 9/11 indirect exposure (n = 3981), the PTSD risk was 0.3%. Of the total sample, 0.7% experienced PTSD in relation to indirect 9/11. Explanations for the lower estimates are discussed.