Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection

Abstract

Background: Lung resections carry a significant risk of complications necessitating the characterization of peri-operative risk factors. Unhealthy alcohol use represents one potentially modifiable factor. In this retrospective cohort study, the largest to date of lung resections in the Veterans Health Administration (VHA), we examined the association between unhealthy alcohol use and postoperative complications and mortality. Methods: Veterans Affairs Surgical Quality Improvement Program data recorded at 86 medical centers between 2007 and 2011 were used to identify 4,715 patients that underwent lung resection. Logistic regression models, adjusted for demographics and comorbidities, were fit to assess the association between unhealthy alcohol use (report of >2 drinks per day in the 2 weeks preceding surgery) and 30-day outcomes. Results: Among 4,715 patients that underwent pulmonary resection, 630 (13.4%) reported unhealthy alcohol use (>2 drinks/day). Overall, postoperative complications occurred in 896 (19.0%) patients, including pneumonia in 524 (11.1%). The rate of mortality was 2.6%. In adjusted analyses, complications were significantly more common among patients with unhealthy alcohol use [odds ratio (OR), 1.42; 95% confidence interval (CI), 1.15-1.74] including, specifically, pneumonia (OR, 1.69; 95% CI, 1.32-2.15). No statistically significant association was identified between unhealthy alcohol use and mortality (OR, 1.27; 95% CI, 0.75-2.02). In secondary analyses that stratified by smoking status at the time of surgery, drinking more than 2 drinks per day was associated with post-operative complications in patients reporting current smoking (OR, 1.51; 95% CI, 1.18-1.91) and was not identified in those reporting no current smoking at the time of surgery (OR, 1.23; 95% CI, 0.79-1.85). Conclusions:In this large VHA study, 13% of patients undergoing lung resection reported drinking more than 2 drinks per day in the preoperative period, which was associated with increased risk of postoperative complications. Unhealthy alcohol use may be an important target for perioperative risk-mitigation interventions, particularly in patients who report current smoking.

Sex and Survival After Surgery for Lung Cancer

“… 49 By contrast, squamous cell carcinoma was associated inversely with any level of alcohol drinking. Alcohol dependency also has been associated with an increased risk of postoperative complications in patients undergoing lung cancer surgery 50 , 51 ; however, the results are conflicting regarding the effect on mortality. 50 , 51 , 52 , 53 Taken together, efforts aiming to reduce excessive alcohol consumption and to prevent dependency may have the potential to decrease morbidity and mortality in patients with lung cancer, particularly among men.…”

Predictors of 30-Day Pulmonary Complications after Video-Assisted Thoracoscopic Surgery Lobectomy

“…While the cutoffs and metrics for measuring alcohol consumption may be heterogenous between studies, it was consistently identified as a key modifiable risk factor for postoperative morbidity. 32 A VASQIP analysis of veterans undergoing lung resection by Graf et al 33 also found alcohol consumption to be associated with increased postoperative pneumonia. While that study examined both open and VATS lung resection cases, it addressed the same veteran population and adds emphasis to the predictive risk that alcohol consumption carries.…”

“…Prior studies have linked preoperative alcohol consumption with postoperative complications. [32][33][34] In a 2013 meta-analysis, Eliasen et al 32 reported that preoperative alcohol consumption was significantly associated with overall postoperative morbidity, including pulmonary complications. While the cutoffs and metrics for measuring alcohol consumption may be heterogenous between studies, it was consistently identified as a key modifiable risk factor for postoperative morbidity.…”

Optimisation of the high-risk thoracic surgical patient: a narrative review

“…A significantly greater proportion of patients who abuse alcohol are also smokers, when compared to the general population. The authors showed that unhealthy alcohol use with smoking was associated with an increased risk of postoperative complications when compared to patients who did not smoke (116). This points to the synergistic role of alcohol and smoking.…”