The findings underscore the need for screening before surgery and targeted interventions.
Using the National Inpatient Sample (2016–2019), researchers analyzed data from 3 million adults who underwent major operations, including colectomy, cardiac surgery, and liver resection. Among them, 16,504 (0.5%) were diagnosed with AWS, including 6,591 (0.2%) with life-threatening delirium tremens (DT). DT is a severe form of alcohol withdrawal that can include shaking, confusion, and hallucinations.
“AWS is a preventable complication, yet it’s often overlooked in surgical planning,” said lead author Timothy M. Pawlik, MD, PhD, MPH, FACS, surgeon-in-chief at the Ohio State University Wexner Medical Center. “Our study shows that proactive screening and multidisciplinary care — involving surgeons, social workers, and addiction specialists — can save lives and reduce costs.”
Key Findings
High-risk patients: AWS was more common in men (median age 61), Medicaid recipients, and those with substance use disorders.
Complications: AWS doubled the risk of respiratory failure and sepsis. DT increased mortality by 40%.
Economic impact: Adjusted hospitalization costs rose by $10,030 per patient with AWS; DT added another $5,300.
Interventions for the Future
The study highlights actionable strategies to improve outcomes:
Preoperative screening: Use validated tools (e.g., AUDIT-C) to identify high-risk patients.
Judgment-free care: “This is a disease, not a moral failing,” stressed Dr. Pawlik. “We need honest conversations to tailor treatment.”
Early intervention: For patients at risk, preventative medications (e.g., benzodiazepines) and ICU-level monitoring may prevent DT.
“A patient recovering from major surgery shouldn’t also battle withdrawal,” said Dr. Pawlik, recalling a case where AWS led to aspiration pneumonia post-surgery. “We can change this by addressing alcohol use before surgery and ensuring safer recovery environments.”
Limtations: The study relied on administrative data, potentially underestimating AWS incidence. Long-term outcomes and treatment specifics (e.g., benzodiazepine use) were not assessed.
Coauthors are Azza Sarfraz, MBBS; Areesh Mevawalla MD; Abdullah Altaf, MD; Mujtaba Khalil, MD; Zayed Rashid, MD; Shahzaib Zindani MD
The study is published as an article in press on the JACS website.
Citation: Nationwide Trends and Perioperative Outcomes of Alcohol Withdrawal Syndrome After Major Operation. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000001487
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