Elective Surgery for Patients with Substance Use Disorder or Recent Substance Misuse

The risks associated with performing elective surgery on patients with substance use disorder or recent substance misuse are considerable and include increased tolerance or other interactions with anesthetic agents, increased risk for respiratory or cardiopulmonary events, increased surgical bleeding, higher risk for postoperative infection, and often increase overall costs. Surgeons should include an evaluation of each patients prior and current substance use history during the pre-procedural history and physical exam, focusing on the recency and extent of use, and discuss the surgical and anesthetic risks with the patient prior to scheduling elective surgery. In some cases these risks necessitate delaying surgery to allow for time to refrain from substance use preoperatively, and may also provide a motivation to quit that did not exist earlier.