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Identification and management of unhealthy alcohol use in the perioperative period

Adam J Gordon, MD, MPH, FACP, FASAM
Section Editor
Richard Saitz, MD, MPH, FACP, DFASAM
Deputy Editor
Richard Hermann, MD


Patients with unhealthy alcohol use face multiple risks in the perioperative period. Patients with risky alcohol use have an elevated risk of alcohol-associated medical and psychiatric problems, which if present can contribute to perioperative complications. Alcohol consumption may interact with perioperative medications and compliance with treatment or recovery in the postoperative period. Patients with frequent heavy alcohol use (including those with a moderate to severe alcohol use disorder) face these risks along with additional risks of physiologic dependence and withdrawal, which can contribute to morbidity directly and through increased complications of surgery.

Patients anticipated to have surgery should be screened for unhealthy alcohol use. Those assessed with or suspected of having frequent heavy use should be monitored closely for alcohol withdrawal and encouraged to undergo medically supervised withdrawal prior to surgery. If surgery is needed urgently, or supervised withdrawal is refused by the patient, he or she should be treated prophylactically with benzodiazepines to prevent withdrawal symptoms. Patients with unhealthy drinking should be educated about the consequences of their use and encouraged to participate in brief counseling or alcohol use disorder treatment, as appropriate.  

This topic reviews the epidemiology, consequences, identification, and management of unhealthy alcohol use in patients hospitalized for surgery. The epidemiology, clinical manifestations, course, assessment, diagnosis, and treatment of patients with alcohol use disorder are described separately. The diagnosis and management of alcohol withdrawal are also described separately. (See "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Screening for unhealthy use of alcohol and other drugs in primary care" and "Brief intervention for unhealthy alcohol and other drug use" and "Psychosocial treatment of alcohol use disorder" and "Pharmacotherapy for alcohol use disorder" and "Management of moderate and severe alcohol withdrawal syndromes" and "Medically supervised alcohol withdrawal in the ambulatory setting".)


The identification and management of patients with unhealthy alcohol use in the perioperative period is aided by defining the spectrum of problems encountered. (See "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis".)

Unhealthy alcohol use — Unhealthy alcohol use encompasses the spectrum of alcohol use that can (but may not necessarily) result in health-related consequences, including risky alcohol use, which includes frequent heavy alcohol use, and alcohol use disorder [1].

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Literature review current through: Oct 2017. | This topic last updated: Apr 12, 2016.
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