Peri‐operative behavioural change and alcohol moderation: insights from local experience

We would like to congratulate Dr McDonald et al. for their very interesting research 1 in assessing patients’ readiness for behavioural change before surgery from three different aspects (motivation, confidence and priority) and the ability to maintain those changes for short- or long-term. We agree with the authors that a structured, tailored support programme is needed in order to take advantage of the ‘teachable moment’ for behavioural change. We would like to share our experience regarding pre-operative alcohol moderation in our patients. As highlighted by McDonald et al., patients are optimistic about alcohol moderation and this presents a unique opportunity for pre-operative behaviour modification. The first hurdle we encountered was to understand the scale of the problem. As described by Stockwell et al. 2, our patients underestimated their alcohol consumption if asked an open question without the help of picture charts to calculate alcohol units. Fifteen of the 30 (50%) patients who were consuming alcohol drank more than 14 units per week and 8 (27%) were drinking more than 21 units per week, potentially worsening their peri-operative outcome 3. None of these patients had any support to try to moderate alcohol consumption pre-operatively. Our audit results also highlighted that pre-operative smoking cessation support was more commonly offered than alcohol moderation help. We also found confusing information regarding pre-operative guidance for alcohol intake from the Royal College of Anaesthetists (RCoA) 4, enhanced recovery after surgery (ERAS) 3 and Cochrane review 5. The RCoA advice is to reduce alcohol to less than 14 units per week, whereas ERAS and the Cochrane review encourage abstinence for 4 weeks before surgery. Published literature demonstrates that the most effective patient engagement initiatives were when face-to-face interview and shared decision-making between the patient and physician were undertaken, in addition to easy access to the relevant services 6. We suggest having an in-house care pathway bundle provided within the peri-operative medicine service.