Management of Alcohol Withdrawal in Microvascular Head and Neck Reconstruction

Abstract

Alcohol use is a risk factor for head and neck cancer. One of the primary therapeutic modalities is surgical tumor ablation followed by immediate reconstruction. Such therapy places patients in a controlled environment, without alcohol, creating the risk of alcohol withdrawal syndrome. The authors attempted to identify the incidence of alcohol withdrawal among patients undergoing free-flap reconstruction for head and neck cancer and were interested in the effect of alcohol withdrawal on the postoperative course of affected patients. In this retrospective review of 51 patients, six experienced alcohol withdrawal or delirium tremens. No difference in the rate of overall complications was seen between the patients who experienced withdrawal and those who did not, although patients who experienced withdrawal did have a statistically significant ratio of non-flap-related to flap-related complications. A review of the current management for alcohol withdrawal is included and places an emphasis on preoperative screening, close observation, rapid diagnosis, and immediate medical care.

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

“…The detrimental postoperative effects of chronic alcohol abuse, and specifically AWS, can potentially be lessened through abstinence from alcohol or prophylaxis against and/or proactive treatment of the symptoms directly related to the withdrawal process 1, 15, 25. Abstinence from alcohol for 4 weeks may reduce postoperative morbidity,29 and prophylactic treatment may prevent complications in patients at risk for AWS 14. Bertrand et al6 reported that preoperative nursing interventions aimed at reducing alcohol intake and the initiation of proactive prophylaxis decreased the rate of AWS in otolaryngology patients from 66% to 28%, with a reduction in intensive care unit (ICU) utilization.…”

“…As many as 66% to 82% of patients who chronically abuse alcohol develop alcohol withdrawal symptoms (AWS) of autonomic hyperactivity with cessation of use following surgery and may subsequently experience postoperative complication rates as high as 50% to 55% 6, 9, 13. Preoperative abstinence and benzodiazepine prophylaxis have been shown to decrease the incidence of AWS in patients at risk and is associated with a decrease in postoperative complications, but does not prevent AWS in all patients at risk 9, 14, 15. Limited data exist regarding the effects of alcohol abuse and alcohol withdrawal on outcomes and costs of care in HNCA surgical patients.…”

“…6,9,13 Preoperative abstinence and benzodiazepine prophylaxis have been shown to decrease the incidence of AWS in patients at risk and is associated with a decrease in postoperative complications, but does not prevent AWS in all patients at risk. 9,14,15 Limited data exist regarding the effects of alcohol abuse and alcohol withdrawal on outcomes and costs of care in HNCA surgical patients. We sought to determine the effect of alcohol abuse and alcohol withdrawal on in-hospital mortality, postoperative complications, length of stay, and hospital costs in patients undergoing HNCA surgery.…”

Alcohol Withdrawal Prophylaxis in Patients Undergoing Surgical Treatment of Head and Neck Squamous Cell Carcinoma

“…Both the severity and type of postoperative complications appears to differ between patients undergoing surgery for head and neck cancer who develop alcohol withdrawal symptoms compared with patients who do not develop withdrawal. Weinfeld et al 2 found a statistically significant difference in the ratio of nonsite‐related to site‐related complications in patients with AWS compared with those without symptoms of alcohol withdrawal. The majority of complications in their patients with AWS were systemic (75%), and all were classified as major.…”

“…Many patients become physiologically dependent on the central nervous inhibitory effects of alcohol after prolonged use. Consequently, patients may develop symptoms of autonomic hyperactivity such as tachycardia, diaphoresis, hyperthermia, and hypertension as a result of withheld consumption during hospitalization after surgical resection 2 …”