PhD Thesis by Julie Weber Melchior Egholm
Risky consumption of alcohol is a global burden. Patients who overuse alcohol are overrepresented in emergency departments and surgical wards. These patients have an increased risk of postoperative complications together with prolonged hospital stays and admissions to intensive care units after surgery. In elective surgery, preoperative alcohol cessation interventions can reduce postoperative complications. To date, no studies have investigated the effect of intensive alcohol cessation intervention at the time of acute surgical emergency procedures on postoperative complications. The purpose of this thesis is to establish new evidence on the prevention of complications in acute surgical patients with risky alcohol intake.
The thesis was based on two studies described in four papers. The first study was a randomised controlled trial (RCT) – the Scand-Ankle study – that aimed to evaluate the effects of a gold standard programme for alcohol cessation intervention (GSP-A) in the perioperative period on postoperative complications and alcohol intake, which are described in a protocol (paper I) and at 6-week follow-up (paper II) and 1 year follow-up (paper III). The second study was a systematic review with the objective assessing the effect of perioperative alcohol cessation interventions on the rate of postoperative complications and postoperative consumption of alcohol.
In paper II, the GSP-A showed a significant effect on successful cessation of alcohol in the 6-week perioperative period (51% vs. 14%; p=0.001), but it did not significantly change the complication rate (42% vs. 34%; p=0.49) or costs (€8,279 vs. €9,320; p=0.63) after trauma surgery. In paper III, at the 1-year follow-up, the participants had relapsed to their previous drinking habits, and both the intervention and control groups reported a high complication rate of 46% in the GSP-A group versus 55% in control group (p=0.47).
The systematic review (paper IV) included three RCTs. These RCTs evaluated intensive alcohol cessation interventions of four to twelve week duration given to participants undergoing different types of surgical procedures with the aim of complete alcohol cessation prior to surgery. All three studies showed a significant effect on the number of participants with alcohol cessation in the intervention groups. There was a moderate quality of evidence for the effect of the intensive alcohol cessation interventions on postoperative complications.
Generalisation of the results of the Scand-Ankle study and systematic review should be considered carefully because they included relatively few participants, and the intervention studies were performed in a Danish population, which may differ from other populations in other countries.
It is important that the surgical staff identify patients who are vulnerable during surgery to inform them of their increased risk of developing postoperative complications. We need to rethink the strategy for acute surgery in patients with risky alcohol intake to reduce their high risk of postoperative morbidity.