The effect of alcohol abuse and alcohol withdrawal on short‐term outcomes and cost of care after head and neck cancer surgery

Genther, Dane J.; Gourin, Christine G.

doi:10.1002/lary.23348

Cited by 52 publications

(39 citation statements)

References 29 publications

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“…In fact, the risk of myocardial infarction has been reported to be greater among alcoholics (26), suggesting that the proportion of cardiac ICU patients that are likely to withdrawal is higher than that in the general population. The nature of the physiologic response to alcohol withdrawal, characterized by an increased risk of sepsis, seizures, shock and death (17, 18, 21, 27), when added to the increased risk of heart rate abnormalities, ventricular dysrhythmias, re-infarction, shock and death that occur in the acute phase of myocardial infarction (28, 29), pose a significant risk of increased mortality for this vulnerable patient population. For this reason, the rationale to suppress or delay the withdrawal from alcohol until the myocardium has stabilized is one approach that has physiologic merit, but scant evidence to support safe treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

“…Although this study was focused on safety and resource use rather than costs, actual costs of untreated withdrawal have been reported in many studies as a major concern (18). Standardized treatment strategies have been evaluated and have been effective in improving early identification of patients at risk (39).…”

Section: Discussionmentioning

confidence: 99%

“…For example, one hospital bill at discharge totaled $89,818.50 for a patient with an acute MI who suffered alcohol withdrawal, as compared to an average hospital charge of $22,300.00 per case for patients with acute MI in the same fiscal year, and that reported over a decade ago, is an underestimate of costs that might be incurred in this same population today (14). The impact of the problem of alcohol withdrawal on the health care system in terms of personnel, resources, supplies, and financial strain is significant (18). …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Alcohol Withdrawal Prevention: A Randomized Evaluation of Lorazepam and Ethanol--A Pilot Study

Fullwood

Mostaghimi²,

Granger³

et al. 2013

American Journal of Critical Care

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Background Alcohol withdrawal syndrome, characterized by a hyperadrenergic state with confusion, agitation and hallucinations, has detrimental effects on patient safety in the context of acute myocardial infarction (MI). Unexpected hospitalization and sudden cessation of alcohol consumption may result in adverse outcomes including in-hospital complications, increased length of stay, and death. Strategies for safe and effective patient management have not been rigorously studied. Purpose We conducted a randomized evaluation of lorazepam and ethanol/lorazepam to evaluate the safety and efficacy of two strategies for the prevention of alcohol withdrawal syndrome in patients with acute coronary syndromes. Methods Patients (n=57) with myocardial infarction were screened for alcohol dependence using the CAGE questionnaire and randomized to lorazepam or to ethanol with lorazepam. Demographic group differences and complication rates were analyzed using chi square (categorical variables) and t-tests (continuous variables). Safety (composite complication rates) of the treatment strategy was evaluated using Fisher’s exact test. Length of stay was analyzed using Wilcoxon rank-sum test. Results Safety-associated complication rates (self-extubation, delirium tremens, re-infarction) were not different between groups (24% lorazepam vs. 18% ethanol; p=0.56). A trend toward fewer complications in the ethanol group was noted. In addition, no difference was detected between the treatment groups for days spent in the CCU (6.9% lorazepam vs. 2.4% ethanol; p = 0.32) or overall hospital stay (6.2% lorazepam vs. 6.4% ethanol; p = 0.72). Conclusions These findings suggest that a randomized evaluation of treatment strategies to prevent complications associated with alcohol withdrawal in acute MI is safe and feasible. A larger study may provide important evidence for improving clinical outcomes for patients experiencing alcohol withdrawal during acute myocardial infarction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Alcohol Withdrawal Prevention: A Randomized Evaluation of Lorazepam and Ethanol--A Pilot Study

Fullwood

Mostaghimi²,

Granger³

et al. 2013

American Journal of Critical Care

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“…El desarrollo de un síndrome de abstinencia en un paciente hospitalizado por otro motivo conlleva estancias hospitalarias más largas y costes de la asistencia más altos 24 . Además, se asocia a incrementos del riesgo de infección nosocomial, de requerir ventilación mecánica y de la mortalidad 24,25 .…”

Section: Manifestaciones Clínicasunclassified

“…Además, se asocia a incrementos del riesgo de infección nosocomial, de requerir ventilación mecánica y de la mortalidad 24,25 . De ahí la necesidad de identificar aquellos enfermos con un mayor riesgo de presentar formas graves de síndrome de abstinencia, especialmente en el ambiente hospitalario.…”

Section: Manifestaciones Clínicasunclassified

Síndrome de abstinencia alcohólica en pacientes hospitalizados

Monte-Secades

Rey

Guerrero-Sande

2015

Revista Clínica Española

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Alcohol Consumption Among Adults With a Cancer Diagnosis in the All of Us Research Program

et al. 2023

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ImportanceAlcohol consumption is associated with adverse oncologic and treatment outcomes among individuals with a diagnosis of cancer. As a key modifiable behavioral factor, alcohol consumption patterns among cancer survivors, especially during treatment, remain underexplored in the United States.ObjectiveTo comprehensively characterize alcohol consumption patterns among US cancer survivors.Design, Setting, and ParticipantsThis cross-sectional study used data from May 6, 2018, to January 1, 2022, from the National Institutes of Health All of Us Research Program, a diverse US cohort with electronic health record (EHR) linkage, and included 15 199 participants who reported a cancer diagnosis and 1839 patients among a subset with EHR data who underwent treatment within the past year of the baseline survey. Data analysis was performed from October 1, 2022, to January 31, 2023.Main Outcomes and MeasuresPrevalence of current drinking and of risky drinking behaviors, including exceeding moderate drinking (&gt;2 drinks on a typical drinking day), binge drinking (≥6 drinks on 1 occasion), and hazardous drinking (Alcohol Use Disorders Identification Test–Consumption [AUDIT-C] score ≥3 for women or ≥4 for men).ResultsThis study included 15 199 adults (mean [SD] age at baseline, 63.1 [13.0] years; 9508 women [62.6%]) with a cancer diagnosis. Overall, 11 815 cancer survivors (77.7%) were current drinkers. Among current drinkers, 1541 (13.0%) exceeded moderate drinking, 2812 (23.8%) reported binge drinking, and 4527 (38.3%) engaged in hazardous drinking. After multivariable adjustment, survivors who were younger than 65 years, men, or of Hispanic ethnicity or who received a diagnosis before 18 years of age or ever smoked were more likely to exceed moderate drinking (aged &lt;50 years: odds ratio [OR], 2.90 [95% CI, 2.41-3.48]; aged 50-64 years: OR, 1.84 [95% CI, 1.58-2.15]; men: OR, 2.38 [95% CI, 2.09-2.72]; Hispanic ethnicity: OR, 1.31 [95% CI, 1.04-1.64]; aged &lt;18 years at diagnosis: OR, 1.52 [95% CI, 1.04-2.24]; former smokers: OR, 2.46 [95% CI, 2.16-2.79]; current smokers: OR, 4.14 [95% CI, 3.40-5.04]) or binge drink (aged &lt;50 years: OR, 4.46 [95% CI, 3.85-5.15]; aged 50-64 years: OR, 2.15 [95% CI, 1.90-2.43]; men: OR, 2.10 [95% CI, 1.89-2.34]; Hispanic ethnicity: OR, 1.31 [95% CI, 1.09-1.58]; aged &lt;18 years at diagnosis: OR, 1.71 [95% CI, 1.24-2.35]; former smokers: OR, 1.69 [95% CI, 1.53-1.87]; current smokers: OR, 2.27 [95% CI, 1.91-2.71]). Survivors with cancer diagnosed before 18 years of age or who ever smoked were more likely to be hazardous drinkers (aged &lt;18 years at diagnosis: OR, 1.52 [95% CI, 1.11-2.08]; former smokers: OR, 1.83 [95% CI, 1.68-1.99]; current smokers: OR, 2.13 [95% CI, 1.79-2.53]). Of 1839 survivors receiving treatment as captured in the EHR, 1405 (76.4%) were current drinkers, and among these, 170 (12.1%) exceeded moderate drinking, 329 (23.4%) reported binge drinking, and 540 (38.4%) engaged in hazardous drinking, with similar prevalence across different types of cancer treatment.Conclusions and RelevanceThis cross-sectional study of a diverse US cohort suggests that alcohol consumption and risky drinking behaviors were common among cancer survivors, even among individuals receiving treatment. Given the adverse treatment and oncologic outcomes associated with alcohol consumption, additional research and implementation studies are critical in addressing this emerging concern among cancer survivors.

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The effect of alcohol abuse and alcohol withdrawal on short‐term outcomes and cost of care after head and neck cancer surgery

Abstract: Alcohol withdrawal is associated with an increase in postoperative medical and surgical complications, length of hospitalization, and hospital-related costs in HNCA surgical patients. Aggressive measures to prevent the development of AWS in patients who abuse alcohol are warranted.

Cited by 52 publications

References 29 publications

Alcohol Withdrawal Prevention: A Randomized Evaluation of Lorazepam and Ethanol--A Pilot Study

Alcohol Withdrawal Prevention: A Randomized Evaluation of Lorazepam and Ethanol--A Pilot Study

Síndrome de abstinencia alcohólica en pacientes hospitalizados

Alcohol Consumption Among Adults With a Cancer Diagnosis in the All of Us Research Program

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