Worth the Risk? Standardized Screening to Identify Substance Use Among Patients Prior to Surgery
Document Type
Article
Publication Title
Annals of Surgery
Abstract
Objective: We sought to compare identification of unhealthy substance use before surgery using The Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS), a standardized 4-item instrument, versus routine clinical documentation in the electronic medical record (EHR).
Summary background data: Over 20% of individuals exhibit unhealthy substance use before elective surgery. Routine EHR documentation is often based on non-standard questions that may not fully capture the extent of substance use and is subject to bias. In contrast, brief standardized screening could provide a more efficient and systematic approach.
Methods: We conducted a cross-sectional study among adults (≥18 y) at a preoperative clinic from August to September, 2021. Positive screens for unhealthy substances by TAPS were compared to data from the EHR. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were reported. Receiver operating characteristic curves (ROCs) were used to assess diagnostic ability. Multivariable logistic regression was used to estimate the predictors of positive screens by TAPS.
Results: The cohort included 240 surgical patients. TAPS screening identified significantly more positive screens than EHR documentation (43.3% vs. 14.2%). Patients with unhealthy substance use were younger (50.8 vs. 56.7 y; P=0.003), and TAPS revealed alcohol misuse in 30.8% of cases, contrasting with 0% in clinician documentation (P
Conclusion: Standardized TAPS screening detected preoperative unhealthy substance use more frequently than routine clinician documentation, emphasizing the need for integrating standardized measures into surgical practice to ensure safer perioperative care and outcomes.
DOI
10.1097/SLA.0000000000006358
Publication Date
5-29-2024
Keywords
perioperative opioid prescribing, screening, substance use disorders
ISSN
1528-1140
Recommended Citation
Cooley S, Bicket MC, Mohammed H, Lai Y, Evilsizer S, Brummett CM, Waljee JF. Worth the Risk? Standardized Screening to Identify Substance Use Among Patients Prior to Surgery. Annals of Surgery. 2024; . doi: 10.1097/SLA.0000000000006358.
