In a study that may far-reaching implications for both Eastern and Western health practitioners, researchers from the University of Colorado have examined the use of complementary and alternative medicine by surgical patients.

Their findings, published in the American Association of Nurse Anesthetists Journal,¹ show that more than half of all surgical patients consume herbs, vitamins, dietary supplements or homeopathic remedies before surgery, a number of which may lead to unwanted (and in some cases, dangerous) side-effects in some patients.

The study underscores the dramatic increase in the use of alternative medicine - particularly herbal supplements - in the United States over the past decade. It also highlights the need for better communication and understanding between practitioners and patients.

"Most patients who take alternative medicines never tell their providers about it," said Carrol Norred, a certified registered nurse anesthetist and the study's lead author. "This can compromise a patient's safety if these medicines aggravate a health condition or interact poorly with the drugs used during surgery."

Norred, along with Drs. Stacy Zamudio and Susan Palmer, surveyed 500 elective surgical outpatients (174 male, 281 female, 45 non-reporting) about their use of alternative medicine during the two weeks prior to surgery. Patients were invited to fill out a questionnaire which contained the common names of several vitamins, herbs, supplements and homeopathic formulas. Surveys were collected from patients just prior to surgery.

Slightly more than half of the patients surveyed (51%) reported taking some type of alternative medicine in the two weeks immediately preceding surgery. Use was higher among females than males (54% vs. 41%), with podiatric and thoracic surgery patients being the most frequent consumers of alternative medicine.

The most popular products consumed were dietary supplements (44% of all patients), followed by vitamins (41%), herbs (5%) and homeopathic remedies (1%). One hundred and twenty-one patients (24%) reported taking combinations of two or more products. Garlic and cranberry were the two most often used herbs; seven percent of patients reported taking either product. Thirty-seven percent of patients used vitamin C; 31% took a multivatmin supplement. Among dietary supplements, calcium was the most popular (7%), followed by fish oil (4%). Arnica, a homeopathic remedy, was used by one percent of patients.

Some Products Linked to Surgical Side-Effects

A surprising number of items consumed by patients prior to surgery contained substances that could lead to possible complications during surgery. For example, 27% of patients consumed products that could prolong blood coagulation, including capsicum, chamomile, garlic, kava kava, fish oil, and some Chinese herbs. Another 10% of patients used multiple supplements that could affect the ability of the blood to clot.

Particular attention was paid to the use of herbs and their potential side-effects in surgical patients. Twelve percent of patients took herbal products such as black cohosh, ephedra and St. John's wort that could have an adverse impact on blood pressure levels during surgery. Nine percent of patients took herbs that could produce sedative effects. Five percent took herbs that may be linked to cardiac irregularities, while four percent took herbs that may affect the body's electrolyte levels.

Greater Communication Leads to Greater Patient Safety

An increasing number of patients are turning to alternative medicine, either as a way of giving themselves more power over their own health, or because they are not satisfied with the results of conventional care. The latest research on the subject shows that patients now make more visits to "unconventional" practitioners than their "conventional" counterparts, and are willing to pay out-of-pocket for treatment.²

Along with that trend has come the alarming fact that many patients do not share information about alternative medicine use with their practitioners. One recent study, in fact, suggested that as much as 70% of individuals who use alternative medicines do not discuss it with their doctors, but instead choose to self-diagnose and self-treat their illnesses.³

Because many patients do not discuss alternative medicine use with their providers, there is a growing risk that such a lack of communication could ultimately compromise the safety of the patient. The results of the AANA study should therefore be seen as a wake-up call, not just to practitioners who treat surgical patients, but to health professionals of all genres, to keep the lines of communication open. As the authors of the study state in their conclusion:

"Open communication and greater knowledge of alternative therapies by health care providers can prevent adverse reactions or complications from unconventional treatments · Further study and scientific research are needed before complementary and alternative medicines are safely integrated into the future management of the surgical patient."

References

1. Norred C, Zamudio S, Palmer SK. Use of complementary and alternative medicines by surgical patients. AANA Journal February 2000;68(1):13-18.
2. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-97. Results of a follow-up national survey. JAMA 1998;280(18):1569-75.
3. Studdert DM, Eisenberg DM, Miller FH, et al. Medical malpractice implications of alternative medicine. JAMA 1998;280(18):1610-1.

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