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We measured the prevalence and predictors of the use of alternative medicine supplements in surgical patients by way of a self-administered questionnaire in consecutive patients ≥18 yr old awaiting elective noncardiac surgery at five San Francisco Bay Area Hospitals. A total of 2560 patients completed the study survey (60% response rate). Of these patients, 39.2% admitted to using some form of alternative medicine supplements, of which herbal medicine was the most common type (67.6%). Of those who admitted to taking alternative medicine supplements, 44.4% did not consult with their primary physicians, and 56.4% did not inform the anesthesiologists before surgery regarding their use of these products; 53% of the patients ceased the use of these products before surgery. Multivariate logistic regression analysis revealed the following variables to be associated with the preoperative use of herbal medicine: female sex (odds radio [OR] 1.42, confidence interval [CI] 1.17–1.72), age 35–49 yr (OR 1.25, CI 1.02–1.53), higher income levels (OR 1.85, CI 1.50–2.27), Caucasian race (OR 1.34, CI 1.07–1.67), higher level of education (OR 1.35, CI 1.10–1.65), problems with sleep (OR 1.32, CI 1.05–1.66), problems with joints or back (OR 1.27, CI 1.04–1.56), allergies (OR 1.48, CI 1.21–1.82), problems with addiction (OR 1.90, CI 1.25–2.89), and a history of general surgery (OR 1.25, CI 1.03–1.52). In contrast, diabetes mellitus (OR 0.55, CI 0.36–0.86) and the use of antithrombotic medications (OR 0.57, CI 0.38–0.87) were associated with decreased odds of the use of herbal medicines. We concluded that the use of alternative medicine supplements by surgical patients is prevalent. Documentation of the use of these products is critical to determine the potential of drug or anesthetic interactions in the perioperative period.