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Patients with AUDIT-C scores of 0 were described in the cohort but excluded from the primary comparative analyses to account for potential J-shaped associations between abstinence and health outcomes. The primary outcome was a composite of surgical complications, emergency department visits, hospital readmissions or mortality within 30 days of surgery. Secondary outcomes included hospital length of stay and postoperative opioid prescribing from discharge through 6\u2009months. Univariable and multivariable logistic regression models were used to evaluate associations between AUDIT-C scores and postoperative outcomes. Additional analyses included Kaplan-Meier survival analysis, receiver operating characteristic curves and feature importance modelling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>9538 (31.1%) of 30\u2009708 eligible surgical patients completed the AUDIT-C, and screening was more common among younger, healthier patients. Among screened patients, 5440 (57.0%) were female and 7405 (77.6%) identified as non-Hispanic White. A total of 805 (8.4%) of screened patients reported at-risk alcohol use. The primary outcome, composite adverse postoperative outcomes, occurred in 13.9% of low-risk patients and 14.5% of at-risk patients (p=0.637). In unadjusted analyses, no significant differences were observed between alcohol risk groups for individual postoperative outcomes, including complications, 30-day readmissions, emergency department visits or mortality. Multivariable logistic regression confirmed no association between AUDIT-C category and the primary composite outcome (average marginal effect 0.01, 95%\u2009CI \u22120.02 to 0.03). Median hospital length of stay differed slightly between groups (3.0\u2009days (IQR 4.0) vs 3.0\u2009days (IQR 5.0); p=0.01). In adjusted Cox proportional hazards modelling, at-risk alcohol use was associated with a slightly lower hazard of discharge compared with low-risk alcohol use, corresponding to a modestly longer time to discharge (HR=0.92, p=0.041). Time to readmission did not differ significantly. Opioid prescribing at discharge was similar across groups (58.4% vs 58.9%, p=0.763).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this real-world surgical cohort, observed AUDIT-C risk category among patients who completed screening was not significantly associated with short-term postoperative outcomes or opioid prescribing. While small differences in length of stay reached statistical significance, their clinical relevance is uncertain. Limitations include limited number of at-risk patients, non-response bias and the absence of standardised follow-up for at-risk patients, which may have contributed to null findings. Future efforts should focus on improving screening through workflow integration, surgical team engagement and follow-up interventions to fully realise benefits from alcohol screening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-115746","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:55:33Z","timestamp":1785844533000},"page":"e115746","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association between inpatient AUDIT-C alcohol screening scores and postoperative outcomes: a retrospective cohort study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1355-8583","authenticated-orcid":false,"given":"Toby","family":"Chen","sequence":"first","affiliation":[{"name":"Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne C","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Evilsizer","sequence":"additional","affiliation":[{"name":"Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA"},{"name":"Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6152-2203","authenticated-orcid":false,"given":"Chiao-Li","family":"Chan","sequence":"additional","affiliation":[{"name":"Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA"},{"name":"Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidhya","family":"Gunaseelan","sequence":"additional","affiliation":[{"name":"Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA"},{"name":"Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer F","family":"Waljee","sequence":"additional","affiliation":[{"name":"Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA"},{"name":"Division of Plastic Surgery, Department of Surgery, Indiana University, Bloomington, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9406-5953","authenticated-orcid":false,"given":"Mark C","family":"Bicket","sequence":"additional","affiliation":[{"name":"Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA"},{"name":"Anesthesiology and Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"2026080404551073000_16.8.e115746.1","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1016\/S2468-2667(19)30231-2","article-title":"National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study","volume":"5","author":"Shield","year":"2020","journal-title":"The Lancet Public Health"},{"key":"2026080404551073000_16.8.e115746.2","unstructured":"World Health Organization . 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