• Anne C Fernandez, Jennifer F Waljee, Vidhya Gunaseelan, Chad M Brummett, Michael J Englesbe, and Mark C Bicket.
• Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, MI.
• Ann. Surg. 2023 Oct 1; 278 (4): e740e744e740-e744.

ObjectiveTo assess the prevalence of and identify characteristics associated with unhealthy use before surgery.BackgroundAlthough the escalation in US drug overdose deaths is apparent, the unhealthy use of substances among patients presenting for surgery is unclear.MethodsWe 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.ResultsAmong 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)].ConclusionsAs 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.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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