Preoperative alcohol cessation prior to elective surgery
Abstract
Background
Hazardous drinking has been associated with an increased postoperative complication rate after surgery. Common complications include postoperative infections, cardiopulmonary complications, and bleeding episodes. Preoperative abstinence may to some degree reverse alcohol‐induced pathophysiological processes and thus prevent postoperative complications.
Objectives
To assess the effect of preoperative alcohol cessation interventions on the rate of postoperative complications including mortality in hazardous drinkers. To assess the effect of preoperative alcohol cessation interventions for hazardous drinkers on alcohol use in the postoperative period and in the long term.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 9); Ovid MEDLINE (1966 to September 2011); Ovid EMBASE (1966 to September 2011); CINAHL via EBSCOhost (1982 to September 2011). We combined the MEDLINE search strategy with the Cochrane highly sensitive search strategy, as contained in the Cochrane Handbook for Systematic Reviews of Interventions, to identify randomized controlled trials (RCTs).
Selection criteria
We included all randomized controlled trials (RCTs) that evaluated the effects of a preoperative alcohol cessation intervention on postoperative complications or postoperative alcohol consumption, or both, in the short and long term in hazardous drinkers . We excluded intraoperative and postoperative alcohol interventions.
Data collection and analysis
Three authors independently assessed studies to determine eligibility and extracted data using a tool based on guidance in the Cochrane Handbook for Systematic Reviews of Interventions. Where required, we obtained additional information through collaboration with the original author. We presented the main outcomes as dichotomous variables. Where data were available, we planned to conduct subgroup analyses as well as a sensitivity analysis to explore risk of bias.
Main results
We included two studies which involved 69 patients. Both studies were RCTs evaluating the effect of intensive alcohol cessation interventions including pharmacological strategies for alcohol withdrawal and relapse prophylaxis.
Our primary outcome measure was postoperative complications and in‐hospital and 30‐day mortality. Meta‐analysis showed an effect on the overall complication rates (odds ratio (OR) 0.22; 95% confidence interval (CI) 0.08 to 0.61; P = 0.004). There was no significant reduction of in‐hospital and 30‐day mortality (OR 0.39; 95% CI 0.06 to 2.83; P = 0.35).
Secondary outcomes included length of stay and postoperative alcohol use. No significant reduction was found.
Authors' conclusions
Based on the finding of two studies, it appears that intensive preoperative alcohol cessation interventions, including pharmacological strategies for relapse prophylaxis and withdrawal symptoms, may significantly reduce postoperative complication rates. No effect was found on mortality rates and length of stay.
The effect of preoperative alcohol cessation intervention should be further explored in an effort to reduce the adverse effect of alcohol use on surgical outcomes. The number needed to screen to identify eligible patients for alcohol intervention studies in surgical settings seems to be extremely high. This may indicate that these studies are difficult to perform. Nevertheless, timing, duration and intensity of alcohol cessation interventions need to be subject to further investigation.
PICOs
Plain language summary
The effect of alcohol cessation on complications following surgery
Hazardous drinking affects human health in several ways, even in patients without an alcohol‐related disease. These include an increased risk of surgical complications. In addition to the well known alcohol‐induced disorders of the liver, pancreas, and nervous system; heavy drinking affects cardiac function, immune capacity (the body's ability to defend itself against infections), haemostasis (blood clot formation), and surgical stress responses. Cardiac insufficiency and arrhythmias (a disorder of the heart rate) are common among hazardous drinkers. Both are important risk factors for the development of postoperative complications, such as postoperative infections, cardiopulmonary complications (heart and lung complications), and bleeding episodes. Reduced immune capacity is found in most patients drinking three or more alcohol units (AU) per day.
The objective of this review was to assess the effect of alcohol interventions on complications following surgery. Interventions included all alcohol interventions aimed at helping patients to either quit drinking or to reduce their alcohol consumption before surgery. We identified two relevant studies involving 69 patients. Both studies involved intensive alcohol interventions aimed at complete alcohol cessation before surgery. The interventions included pharmacological (drug) strategies for alcohol withdrawal and relapse prophylaxis (relapse prevention) and were four to eight weeks in length (these interventions are comparable to the gold standard smoking cessation interventions).
The results showed that intensive interventions aimed at complete alcohol cessation reduced the number of complications. No effect was found on mortality rates (number of deaths) and length of stay.
Due to the small number of included studies, as well as the small size of the included studies, one should be careful about drawing firm conclusions based upon these results. More research is needed to clarify the most beneficial intervention programme. This includes research on the effect of reduced alcohol consumption and the most beneficial period of alcohol intervention programmes. However, as recruitment of patients to this field of research seems challenging, these studies may be difficult to perform.
