Authors' objectives: The National Institute for Health and Care Clinical Excellence (NICE) recognises that major surgery often represents the only treatment for worsening arthritis. As the population ages, the majority of patients undergoing elective knee and hip replacement surgery are over 65 years of age. Unfortunately, older patients have an increased risk of complications following surgery when compared to their younger counterparts. The reasons for this are unclear but chronological age should not in itself be a barrier to performing surgery. Preoperative detection and reduction of risk factors known to increase complications after surgery, especially in older patients, is becoming increasingly important. For this reason, preoperative assessment clinics are becoming common in the UK. These clinics provide an underutilised, early opportunity to develop interventions that reduce risk of surgery and ultimately improve outcome. Excess preoperative alcohol consumption is a known to be associated with increased complications after surgery, which prevent early recovery and prolong rehabilitation. Therefore any therapy that successfully reduces alcohol consumption before surgery will likely have major implications for patient benefit. The detection of high alcohol consumption, followed by techniques that aim to support patients to reduce alcohol intake through changing attitudes and behaviours, have been successful in reducing consumption levels, in other clinical situations, including accident and emergency, general practice and some hospital wards. These techniques have considerable potential in reducing alcohol consumption before surgery. The present study aims to tailor a detection and brief behaviour-change intervention to an orthopaedic population being referred for major joint surgery. Use of the preoperative assessment clinic will provide a dedicated workforce applying the process at a much earlier stage in the surgical pathway than previously described, thereby hoping to maximise the potential benefit of the intervention. The research will be in two phases: Phase 1:This phase will take place at a preoperative assessment clinic in the North East of England. The first objective will be to establish a nurse-administered preoperative screening tool, to detect higher levels of alcohol consumption in orthopaedic surgical patients. Secondly, one or two conversations between individual patients and dedicated preoperative assessment nurses, will aim to motivate and support the patient to think about and plan a change in drinking habits before surgery. The ease with which these processes are integrated into the surgical pathway and the acceptability of the process to both nurses and patients will be assessed. Phase 2:The optimised screening and behavioural intervention will be applied in a study that will take place in up to three hospitals in the Tyne and Wear area. The intervention will be tested against usual management before surgery . The overall objective of this phase is to provide information to inform a much larger study to promote preoperative alcohol reduction in the orthopaedic population. In summary, the overall proposal is to develop an acceptable screening and behavioural intervention, which can be applied in the early stages of the surgical pathway, and to rehearse the processes for a larger trial.

Project Status: Completed

URL for project: http://www.nets.nihr.ac.uk/projects/hta/144201

Year Published: 2020

URL for published report: http://www.nets.nihr.ac.uk/projects/hta/144201

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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