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Front. Psychol. | doi: 10.3389/fpsyg.2019.00034

Preoperative Interventions for Alcohol & Other Recreational Substance Use: A Systematic Review & Meta-Analysis

 Luke Budworth1, 2*,  Andrew Prestwich1, Rebecca Lawton1, 2, Alwyn Kotze3 and  Ian Kellar1
  • 1University of Leeds, United Kingdom
  • 2Bradford Institute for Health Research, United Kingdom
  • 3Leeds Teaching Hospitals NHS Trust, United Kingdom

Abstract
Background.
Preoperative alcohol and other recreational substance (ORSU) use may catalyse perioperative complications. Accordingly, interventions aiming to reduce preoperative substance use are warranted.
Methods.
Studies recruiting hazardous/dependent alcohol, or other recreational substance users, were identified from: Cochrane Library; MEDLINE; PSYCINFO; EMBASE; and CINAHL.
Interventions to reduce alcohol and/or ORSU in elective surgery patients were included. In both narrative summaries of results and random effects meta-analyses, effects of interventions on perioperative alcohol/ORSU, perioperative complications, mortality and length of stay were assessed.
Primary Results
Nine studies (n = 903) were included. Seven used behavioural interventions only, two provided disulfiram in addition. Pooled analyses found small effects on alcohol use (d: 0.34; 0.05-0.64), though two trials using disulfiram (0.71; 0.36-1.07) were superior to two using behavioural interventions (0.45; -0.49-1.39). No significant pooled effects were found for perioperative complications, length of hospital stay or mortality in studies solely targeting alcohol/ISU. Too few interventions targeting ORSU (k =1) were located to form conclusions regarding their efficacy. Studies were generally at high risk-of-bias and heterogeneous.
Conclusions
Preoperative interventions were beneficial in reducing substance use in some instances, but more high-quality studies targeting alcohol/ORSU specifically are needed. The literature to date does not suggest that such interventions can reduce postoperative morbidity, length of hospital stay or mortality. Limitations in the literature are outlined and recommendations for future studies are suggested.

Keywords: Alcohol consumption, illicit drugs, Perioperative Care, Postoperative Complications, Preoperative Period

Received: 09 Oct 2017; Accepted: 08 Jan 2019.

Edited by:

Gianluca Castelnuovo, Catholic University of Sacred Heart, Italy

Reviewed by:

Ana N. Da Silva, Universidade de Lisboa, Portugal
Giovanni Martinotti, Università degli Studi G. d'Annunzio Chieti e Pescara, Italy  

Copyright: © 2019 Budworth, Prestwich, Lawton, Kotze and Kellar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mr. Luke Budworth, University of Leeds, Leeds, United Kingdom, l.budworth1@leeds.ac.uk