BACKGROUND: Substance use is a modifiable risk factor that may adversely affect surgical outcomes, yet its prevalence using surgical risk-specific thresholds remains incompletely characterized in preoperative populations. STUDY DESIGN: We performed a cross-sectional analysis of preoperative screening data from a clinical trial (NCT05783635) at a large Midwestern health system. Between February 2024 and February 2025, 2,688 adults aged 21-75 years undergoing elective surgery completed validated self-report assessments of alcohol, nicotine, cannabis, and other drug use. High-risk use was defined as Alcohol Use Disorders Identification Test-Consumption scores ≥5 or weekly/daily use of other substances. Polysubstance use was defined as high-risk use of more than one substance. Multivariable logistic regression evaluated associations between patient and surgical factors and high-risk use. RESULTS: Overall, 27.6% (n=743) of patients reported high-risk substance use and 6.6% (n=177) reported polysubstance use. Cannabis was the most prevalent high-risk substance (15.0%), followed by alcohol (11.1%), nicotine (8.5%), and other drugs (0.4%). Younger age, male sex, and poorer self-reported health were associated with increased odds of high-risk use. Prevalence varied across surgical services, with the highest rates in neurosurgery (27.1% high-risk; 11.4% polysubstance) and lowest in endocrine surgery (15.1%; 3.3%). CONCLUSIONS: More than one in four elective surgical patients report high-risk substance use prior to surgery. These findings support universal preoperative substance use screening to identify patients at elevated risk for adverse perioperative outcomes and enable targeted risk mitigation.
Ju et al. (Fri,) studied this question.