Benefits of implementation of a protocol for identification of preoperative chronic alcohol abusers and for alcohol withdrawal syndrome prevention

Oana Avram¹, Irina Grecu², R. Macovei¹, Oana Marinescu²2, Ioana Grinţescu²

1 Spitalul Clinic de Urgenţă Bucureşti, Clinica ATI II – Toxicologie
2 Spitalul Clinic de Urgenţă Bucureşti, Clinica ATI

Abstract

Background and Goal of Study. Alcohol abuse and dependence are common problems in the perioperative setting, which are oftenly misdiagnosed, until alcohol withdrawal syndrome (AWS) occurs. The latter increases perioperative morbidity and length of hospital stay (LOS) and therefore its prophylaxis is important. Our trial is aimed to demonstrate the benefits of implementing a protocol for identification of chronic alcohol abusers, together with AWS prophylaxis in patients scheduled for lower limb orthopedic surgery.

Materials and Methods. After Internal Ethical Board approval and patient informed consent, 865 patients scheduled for lower limb orthopedic surgery between March 2007 and August 2008 were screened on admission for chronic alcohol abuse using a questionnaire and serum CDT (carbohydrate deficient transferin) and GGT (gamma-glutamyl transferase) measurement. Patients having negative CDT + GGT were allocated to group A [n = 757]. Patients having positive CDT + GGT and ± positive questionnaires were randomized to receive daily 20 mg i.m. diazepam – group B [n = 53], or placebo (same volume i.m. saline) – group C [n = 55], for at least 5 perioperative days. All patients who developed AWS received treatment with diazepam, haloperidol and clonidine. Major endpoints were incidence of AWS, complications (infectious and non-infectious), length of stay and mortality. Statistics was done with SPSS for Windows, version 13.0. A value of p < 0.05 was considered significant.

Results and Discussion. Among 865 patients enrolled in the study, 108 patients (12% of cases) with the increased value of serum CDT and GGT were included into groups B and C. Demographic data was similar between groups and also mortality rate. Three patients in group A, 9 patients in group B and 29 patients in group C developed AWS (p = 0.001 group C vs. B). Total complications rate was 6.60% in group A, 11.32% in group B and 25.45% in group C (p = 0.015 in group C vs B and p = 0.000 in group C vs A). LOS was longer in group C vs A and B (16.46 ± 7.90 vs 9.34 ± 3.56 and 7.68 ± 3.74 days, p = 0.004 and p = 0.001, respectively).

Conclusion. Twelve percent of patients scheduled for major orthopedic surgery were chronic alcohol abusers and at risk to develop perioperative AWS. Preoperative identification of chronic alcohol abusers and the prophylaxis of AWS decreased postoperative complications and length of stay in these patients.

Keywords: chronic alcohol abuse, lower limb surgery, alcohol withdrawal syndrome

J Rom Anest Terap Int 2009; 16: 121-127

Beneficiile implementării unui protocol pentru identificarea preoperatorie a pacienţilor cu alcoolism cronic şi profilaxia sindromului de sevraj etilic perioperator