Prevalence of Unhealthy Substance Use and Associated Characteristics Among Patients Presenting for Surgery.

Objective: To assess the prevalence of and identify characteristics associated with unhealthy use before surgery.
Background: Although the escalation in US drug overdose deaths is apparent, the unhealthy use of substances among patients presenting for surgery is unclear.
Methods: We conducted a retrospective study of patients presenting for elective surgical procedures between December 2018 and July 2021 and prospectively recruited to 1 of 2 clinical research studies (Michigan Genomics Initiative, Prevention of Iatrogenic Opioid Dependence after Surgery Study). The primary outcome was unhealthy substance use in the past 12 months as determined using the Tobacco, Alcohol, Prescription medication, and other Substance use tool.
Results: Among 1912 patients, unhealthy substance use was reported in 768 (40.2%). The most common substances with unhealthy use were illicit drugs [385 (20.1%)], followed by alcohol 358 (18.7%)], tobacco [262 (13.7%)], and prescription medications [86 (4.5%)]. Patients reporting unhealthy substance use were significantly more likely to be younger, male [aOR: 1.95 (95% CI, 1.58-2.42)], and have higher scores for pain [aOR: 1.07 (95% CI, 1.02-1.13)], and anxiety [aOR: 1.03 (95% CI, 1.01-1.04)]. Unhealthy substance use was more common among surgical procedures of the forearm, wrist, and hand [aOR: 2.58 (95% CI, 1.01-6.55)].
Conclusions: As many as 2 in 5 patients in the preoperative period may present with unhealthy substance use before elective surgery. Given the potential impact of substance use on surgical outcomes, increased recognition of the problem by screening patients is a critical next step for surgeons and perioperative care teams.
Competing Interests: Dr M.C.B reports past personal fees and other from Axial Healthcare and past personal fees from Alosa Health outside the submitted work. Dr C.M.B. serves as a consultant for Heron Therapeutics, a biotech company that produces a nonopioid analgesic for acute pain, and he served as a one-time consultant for Vertex Pharmaceuticals, Alosa Health, and the Benter Foundation. In addition, Dr C.M.B. provides expert medicolegal testimony unrelated to this viewpoint. The remaining authors report no conflicts of interest.
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