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

• Published in: The Laryngoscope 2012-08, Vol.122 (8), p.1739-1747
• Main Authors: Genther, Dane J., Gourin, Christine G.
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Aged; Aged, 80 and over; Alcohol abuse; alcohol withdrawal; Alcohol Withdrawal Delirium - economics; Alcohol Withdrawal Delirium - mortality; Alcoholism; Alcoholism - economics; Alcoholism - mortality; Alcoholism and acute alcohol poisoning; Biological and medical sciences; Comorbidity; complications; Cross-Sectional Studies; Female; head and neck neoplasms; Health Care Costs; Hospital Mortality; Humans; Length of Stay - economics; Level of Evidence: 2c; Male; Medical sciences; Middle Aged; Nationwide Inpatient Sample; Otorhinolaryngologic Neoplasms - economics; Otorhinolaryngologic Neoplasms - mortality; Otorhinolaryngologic Neoplasms - surgery; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Postoperative Complications - economics; Postoperative Complications - mortality; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies; surgery; Toxicology; Treatment Outcome; Tumors; United States
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.23348

Objectives/Hypothesis: Alcohol abuse is associated with an increased incidence of postoperative complications in surgical patients and is a significant risk factor for the development of head and neck cancer (HNCA). We sought to determine the relationship between alcohol abuse and in‐hospital mortality, postoperative complications, length of stay, and costs in HNCA surgery. Study Design: Retrospective cross‐sectional study. Methods: Discharge data from the Nationwide Inpatient Sample for 92,312 patients aged 18 years and older who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2003 to 2008, were analyzed using cross‐tabulations and multivariate regression modeling. Results: Patients who abused alcohol were more likely to have advanced comorbidity, undergo major surgical procedures, and require medical care at another facility or home healthcare after discharge. The development of alcohol withdrawal symptoms (AWS) was associated with an increased incidence of acute medical complications (odds ratio [OR]: 5.6, P < .001) and surgical complications (OR: 2.3, P < .001). After controlling for all other variables, there was no significant association of alcohol abuse or AWS with in‐hospital mortality; however, alcohol abuse and AWS were associated with significantly increased length of hospitalization and hospital‐related costs, with AWS having the single largest impact on length of stay and costs. Conclusions: 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. Laryngoscope, 2012