Preoperative Substance Use: 
Risk Analysis and Preliminary Intervention Development

Lead: Dr Luke Budworth (PhD project)
Supervisors:  Andrew Prestwich, Rebecca Lawton, Ian Keller (all University of Leeds), Dr Alwyn Kotze (Leeds Teaching Hospitals NHS Trust)

Background. Perioperative substance use may catalyse perioperative complications. Nevertheless, a literature review for this project found little (particularly UK) research investigating the extent and detectability of this issue (risk analysis), nor methods to counteract the issue (intervention research). There are also plausible but unexplored routes through which substance use may have negative perioperative effects (e.g., mental health impacts).

Studies and findings. Through secondary data analysis, Study 1 (= 18,508) found that (in covariate-adjusted models) hazardous preoperative alcohol use may negatively impact postoperative affect (which may catalyse complications). Across two Leeds-based preoperative assessment clinics, Study 2 and 3 (= 196; = 273) found that over a third of preoperative patients had alcohol use scores associated with complications in previous studies and that polysubstance use was high. Routine preoperative assessment measures were less sensitive at detecting hazardous use versus validated measures, though postoperative complications were predicted by neither. In Study 4, a systematic review found few interventions targeting preoperative alcohol use and zero targeting other substance use alone. Effects on substance use were mixed and trial quality was low. Recommendations for future studies included the development of interventions using behavioural determinant elicitation research. In Study 5 (= 102) a (Capability, Opportunity, Motivation – Behaviour [COM-B] based) questionnaire for assessing and targeting determinants of preoperative alcohol use was developed. The questionnaire had good psychometric properties and among preoperative patients, each COM-B subdomain was significantly associated with alcohol consumption (reflective motivation, physical capability and physical opportunity were predictive after controlling for all subdomains). In Study 6 (= 36) thematic analysis of interviews with addiction service users identified several determinants (e.g., low self-efficacy) and intervention features (e.g., individualisation) for future interventions to target and incorporate. 


Publications
1.        Systematic Review smoking cessation: https://www.frontiersin.org/articles/10.3389/fpsyg.2017.00915/full
2.        Systematic review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369879/