Research suggests that getting fit, eating healthily and drinking less alcohol prior to surgery can aid better recovery. In this blog, Rasheda Begum, Publications and Business Coordinator at the Royal College of Anaesthetists (RCoA), describes the benefits of drinking less alcohol both before and after surgery.
Around 10 million patients undergo surgery each year in the NHS. The time available to patients to prepare for surgery is a powerful ‘teachable moment’, to encourage patients to make positive and lasting changes to their lifestyle. One of these changes is of course reduction in alcohol consumption.
When it is known that a patient needs to have surgery or an operation, it is helpful to start thinking about what can be done to aid recovery from surgery such as by reducing smoking, losing weight and reducing alcohol consumption.
Post-operative complication rate for hazardous drinkers increases to 200–400%, compared to those who drink less. Abstaining from alcohol for a period one month in advance of surgery significantly decreases morbidity and mortality. These figures indicated that alcohol use is an important factor to consider during surgery and abstention could benefit patients greatly.
Staying fit and healthy before surgery improves outcomes
The care given during a patient’s surgical procedure is known as perioperative care. An important element of perioperative care is prehabilitation, which focuses on preparing a patient for surgery and getting them as fit as possible. Patients will be advised to drink within recommended limits or lower to improve their healing after surgery.
Perioperative care also consists of shared decision making where patients are empowered to have an active role in their care. To give patients a helping hand, RCoA has a number of patient information resources, in particular the Fitter Better Sooner toolkit which provides patients with information on how to improve their health while they wait for surgery. Patients are encouraged to reduce their alcohol intake as part of their preparation for surgery and the RCoA has taken opportunities such as Dry January and Alcohol Awareness Week to put across this messaging to its members.
RCoA commends the work of the Alcohol Health Alliance (AHA) in addressing the effects of alcohol and society and advocating for change. Like the AHA, we welcome the proposals in the Long Term Plan for the expansion of specialist Alcohol Care Teams (ACTs) in hospitals with the highest rate of alcohol dependence-related admissions, but we also wish to see ACTs rolled out to all hospitals.
There may be opportunities for multidisciplinary collaboration between ACTs and perioperative teams, who, through prehabilitation and comprehensive preoperative assessment, can help identify elective surgery patients requiring targeted interventions, such as referral to an ACT, to help them tackle harmful drinking levels and reduce postoperative complications.
Do behavioural interventions work in a perioperative setting?
Researchers from Newcastle upon Tyne Hospitals NHS foundation Trust and Newcastle University carried out a pilot trial on a brief behavioural intervention to reduce preoperative drinking.
The study involved a nurse-led intervention delivered in the context of a Preoperative Assessment clinic. Patients at high risk were identified through screening by a now nationally recommended Alcohol Use Disorders Identification Test (AUDIT), a ten item questionnaire developed by the World Health Organization that measures alcohol use. Patients were randomised to two groups, either to receive usual care or be provided with a structured behavioural intervention regarding alcohol consumption and engaged in 15-20 minutes of discussion about alcohol consumption including goal setting, problem solving and assessment of motivation to change. The intervention was found to be acceptable to patients and healthcare professionals.
The above case study supports a larger trial to determine the effectiveness of identifying patients at risk of high alcohol consumption before surgery so that interventions can be made to encourage patients to drink less. Patients can thus be empowered to improve their health to ensure that they have fewer complications during surgery and will recover better.
Written by Rasheda Begum
If you are worried about your own or someone else’s drinking, there is help available.
Drinkline is the national alcohol helpline. Calls are free and confidential. Call 0300 123 1110 (weekdays 9.00am to 8.00pm, weekends 11.00am to 4.00pm).
More information about organisations which offer help and support can be found on our support page.
The Royal College of Anaesthetists (RCoA) is a membership body representing the specialty of anaesthesia. Over the past ten years anaesthesia has been at the centre of the development of perioperative care, the integrated multidisciplinary care of patients from the moment surgery is contemplated through to full recovery. Good perioperative care should improve patient experience of care, including quality of care and satisfaction with care, and reduce the per capita cost of healthcare through improving value.
The Centre for Perioperative Care (CPOC) is a new cross-organisational, multidisciplinary initiative led by the RCoA which was established to facilitate cross-organisational working on perioperative care for patient benefit. Another important element of perioperative care is multidisciplinary working, therefore CPOC is fortunate to be working with partners including Royal College of Surgeons, Royal College of Physicians, Royal College of GPs and Royal College of Nursing. Recently CPOC published an evidence review looking at the impact of prehabilitation measures, including perioperative alcohol cessation.
This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Health Alliance or its members.