Table 3.

Summary of Themes and Findings from Provider and Patient Qualitative Interviews

Themes and Findings	Surgical Healthcare Providers	Patients
Knowledge of Alcohol and Surgical Risk	“You could probably tell the healing difference between the, you know, few cigarettes per day person and a non-smoker. But someone drinks six pack of beer per day, it may not actually affect much of anything except for maybe their postoperative pain control and how they come in and out of anesthesia. The anesthesia part doesn’t really affect me per say…” “I think if their hemoglobin A1c is over 8 or 9, some of the attendings would say no to an elective procedure until you get your diabetes under control. So that would be something else…. in terms of alcohol use, that’s not been something that’s stopped us from doing surgery.”	“I haven’t really thought about how alcohol might change the way that the surgery will go. I didn’t know if that was an actual thing that could happen, I guess.” “Everybody’s telling me now that it’s [alcohol] slowing the healing process of my knee, the surgery on my knee, the alcohol. The doctor didn’t say it, but everybody I talk to, they say ‘You know, that’s…that’s slowing you up.”
Alcohol Screening Prior to surgery	“….tobacco is brought to our attention because it is part of the intake questionnaire that the patients fill out. Whereas, I don’t even know...I feel like maybe alcohol use is in there but it’s sort of, not in a way that comes out as clearly. I always know if someone reports being a smoker. It’s not even all that clear to me if I know whether they report their alcohol use.” “I’ve never asked anyone about if they’ve been addicted to something in my life, in my 20 years of practice. It’s just not part of surgical sensibilities. So we’re working on that.” “I’m not sure how well we always screen for alcohol… I think that the statistics show that whatever heavy drinkers say, maybe it’s double what they [say]…Not for everybody, but there’s a certain percentage of people. So I don’t think that we go further into questioning them. And that doesn’t concern us, necessarily. In terms of that’s going to stop us from doing surgery.”	“I reported [alcohol use] a little bit lower, just a little bit, but it’s only because they gonna bring that up. I’m already here. I’m already in pain. The last thing I wanna hear is what I’m doing wrong or whatever...” “I donť feel iťs sensitive. I actually I donť mind disclosing [alcohol use] to the doctor because if there's an emergency or something, I'd rather they know how my lifestyle is and my health and do something about it or have an idea or to solve an issue or situation, which hopefully doesnť happen, but thaťs why I donť mind disclosing that kind of information.”
Alcohol Intervention Prior to Surgery	“I donť think that we've ever not done surgery because of someone's drinking… as long as they’re not smokers because like I said threshold is real low, they won’t even get the surgery date if they’re a smoker. But the alcohol thing we don’t emphasize on. So they can put anything other than like a fifth of vodka and they’ll probably get to surgery.” “So in that particular case this gentleman was not motivated to quit, so the two areas of intervention were to insure he wasn’t driving himself especially while he was being prescribed narcotics and for us to adjust our narcotic prescriptions appropriately. And also in this particular case he needed a shorter procedure and we did it as an outpatient simply so he can get home and start drinking again rather than withdraw in the hospital.”	“I figured if…if there was something really dire that they would tell me ahead of time. You know, say, Oh, no. You gotta stop [alcohol use] for a week. You gotta stop. You have to get it all out of your system for a month or something like that. I would think.… if it were really gonna be a dangerous situation that they would give you warnings about it…” “Cuz I know it [alcohol] thins your blood too and I don’t wanna lose too much or I don’t want that to be the cause of something going wrong. I don’t want it to be on me…. let it be on the doctor so I can blame him…. Yeah, so use this time to get my body right a little bit.”
Interest in Improving Alcohol-Related Care	“So if …. you gave me some amount of money and it was to be used for preoperative health optimization, I would probably spend it on things like smoking, obesity, diabetes….And I would not spend it on alcohol.”	“…if they added something in there that was specific to say, we want you a week before or two weeks before just to stop all consumption of alcohol. Yeah, I don’t see a problem with that. I would probably try to comply with that. I don’t know if I would 100 percent, but I don’t…I don’t have any issues with that if that was laid out to me in this preop folder. I would try to work on that.”