Alcohol

NHS Lothian Prehabilitation

Key Points:

  1. Chronic alcohol excess heightens the stress response to surgery. This results in pathophysiological changes to organ systems leading to increased risk of perioperative complications.
  2. Patients should be advised to drink no more than 14 units of alcohol a week, spread across 3 days or more.
  3. Accurate quantification of alcohol intake in patients approaching major surgery is invaluable.
  4. Support for patients wishing to reduce their alcohol intake is available through a number of online resources and the ELCA Counselling Service

Alcohol and Perioperative Risk

Chronic alcohol excess heightens the stress response to surgery. This results in pathophysiological changes to organ systems leading to increased risk of perioperative complications.

Perioperative risk is related to intake, with a dose-response relationship appearing to exist between alcohol consumption and the incidence of postoperative complications. Risk is highest in patients with manifest features of organ damage and dependence.

Risk increases with a daily intake of 3 units or greater, meaning that patients with a low perceived consumption are at increased perioperative risk.

Any alcohol intake above recommended levels (see below) confers increased perioperative risk. A reduction in intake or preoperative abstinence should be targeted for all patients in this category.

The period of abstinence required to see measurable improvements in complication rates is not clear and may be up to 8 weeks.

Quantification of Alcohol Intake

Given the dose-response relationship between alcohol intake and perioperative risk, accurate quantification of alcohol intake in patients approaching major surgery is invaluable.

It's recommended to drink no more than 14 units of alcohol a week, spread across 3 days or more.

Approximately 23% of UK men and 18% of UK women drink more than 28 units per week (twice the recommended amount).

You can use Count14 Unit Calculator to calculate how many units a patient is drinking.

Drink Number of Units
Bottle of Beer / Lager / Cider 330ml (5%) 1.7
Can of Beer / Lager / Cider 440ml (5%) 2.2
Pint of lower-strength Beer / Lager / cider 568ml (3.6%) 2.0
Pint of higher-strength Beer / Lager / cider 568ml (5.2%) 3.0
Small Glass of Wine 125ml (12%) 1.5
Standard Glass of Wine 175ml (12%) 2.1
Large Glass of Wine 250ml (12%) 3.0
Small measure of Fortified Wine 50ml (17.5%) 0.9
Large measure of Fortified Wine 75ml (17.5%) 1.3
Single shot of Spirit 25ml (40%) 1.0
Standard shot of Spirit 35ml (40%) 1.4
Double shot of Spirit 50ml (40%) 2.0
Alcopop 275ml (4.55) 1.5

 

NHS Lothian Services - Support for Patients

A range of preoperative interventions from simple verbal advice to structured combined pharmacological and behavioural interventions including the involvement of alcohol services may be appropriate.

Patients with an alcohol intake above recommended limits may respond to brief preoperative advice regarding the risk posed to them by their current consumption and be encouraged to cut down or abstain in the approach to surgery.

Online and locally available services for patients wishing to reduce their alcohol intake include:

  • Count14 Website
    • Straight forward instructions on how to assess units, and advice about alcohol intake.
  • NHS Lothian Wellbeing
    • Information and tools to help with wellbeing and mental health including alcohol
  • ELCA Counselling Service
    • ELCA offers help to anyone in Lothian with concerns about their, or someone else’s, drinking, aged 18 or over.
    • ELCA offers drop-In services, advice, information and one to one counselling.

Alcohol Misuse or Harmful Drinking

Patients with established end-organ damage or features of dependence may require early preoperative referral to specialist alcohol services.

The FAST questionnaire is an alcohol harm assessment tool which can be used to screen for patients who may benefit from referral to specialist services.

Lothians and Edinburgh Abstinence Programme (LEAP) is a residential 12 week rehabilitation program with psychiatric and psychological support and 2 year aftercare. Referrals are accepted from any healthcare professional using the referral form which can be downloaded form their website.