Alcohol withdrawal syndrome increases risks and costs after major surgery

Patients who develop alcohol withdrawal syndrome (AWS) after major surgery face significantly higher risks of complications, longer hospital stays, and increased health care costs, according to a study published in the Journal of the American College of Surgeons (JACS). 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. Our study shows that proactive screening and multidisciplinary care - involving surgeons, social workers, and addiction specialists - can save lives and reduce costs." 

Timothy M. Pawlik, MD, PhD, MPH, FACS, lead author, surgeon-in-chief at the Ohio State University Wexner Medical Center

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:

1. Preoperative screening: Use validated tools (e.g., AUDIT-C) to identify high-risk patients.
2. Judgment-free care: "This is a disease, not a moral failing," stressed Dr. Pawlik. "We need honest conversations to tailor treatment."
3. 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.