Nationwide Trends and Perioperative Outcomes of Alcohol Withdrawal Syndrome after Major Operation.

Abstract

Alcohol withdrawal syndrome (AWS) is a potentially life-threatening condition that may complicate the postoperative course of surgical patients. This study aimed to define the incidence, identify risk factors, and evaluate the impact of AWS on patients undergoing major operation. The National Inpatient Sample (2016 to 2019) was used to identify adult patients (18 years or older) who underwent a major surgical procedure. AWS and delirium tremens (DTs) were identified using validated ICD-10 codes. Multivariable regression models were used to evaluate associations with perioperative outcomes including in-hospital mortality, complication, length of stay (LOS), discharge disposition, and hospitalization cost. Among 3,003,140 surgical patients, 16,504 (0.5%) were diagnosed with AWS, including 6,591 (0.2%) with DT. Patients with AWS were younger (median age 61 vs 67 years, p < 0.001), predominantly male (83.7% vs 57.3%, p < 0.001), and more likely to have Medicaid insurance (21.2% vs 8.2%, p < 0.001). AWS was independently associated with increased risk of postoperative complication (adjusted odds ratio [AOR] 1.37; 95% CI 1.27 to 1.48), particularly respiratory failure (AOR 2.44; 95% CI 2.24 to 2.67) and sepsis (AOR 1.61; 95% CI 1.43 to 1.82). Patients with AWS had longer LOS (median 11 vs 6 days, p < 0.001) and higher hospitalization cost ($44,300 vs $28,800, p < 0.001), with an adjusted cost increase of $10,030 per patient (95% CI $8,190 to $11,860). DT further increased mortality risk (AOR 1.40; 95% CI 1.10 to 1.78) and LOS (+5.3 days, p < 0.001). AWS was associated with worse surgical outcomes, extended hospitalization, and increased cost. These findings underscore the need for standardized perioperative screening and targeted management strategies to mitigate AWS-related risks.