Preoperative alcoholism and postoperative morbidity.
BACKGROUND
Preoperative risk assessment has become part of daily clinical practice, but preoperative alcohol abuse has not received much attention.


METHODS
A Medline search was carried out to identify original papers published from 1967 to 1998. Relevant articles on postoperative morbidity in alcohol abusers were used to evaluate the evidence.


RESULTS
Prospective and retrospective studies demonstrate a twofold to threefold increase in postoperative morbidity in alcohol abusers, the most frequent complications being infections, bleeding and cardiopulmonary insufficiency. Wound complications account for about half of the morbidity. The pathogenic mechanisms include preoperative immune incompetence, subclinical cardiac insufficiency and haemostatic imbalance. In addition, surgical trauma and/or postoperative abstinence result in an exaggerated stress response, which may further contribute to postoperative morbidity.


CONCLUSIONS
Alcohol consumption should be included in the preoperative assessment of likely postoperative outcome. Reduction of postoperative morbidity in alcohol abusers may include preoperative alcohol abstinence to improve organ function, or perioperative alcohol administration to avoid the abstinence response.
Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Denmark.
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Tonnesen
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Kehlet
D000437:Alcoholism / Q000150:complications*; D002310:Cardiomyopathy, Alcoholic / Q000209:etiology; D006488:Hemostasis, Surgical; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D013315:Stress, Psychological / Q000209:etiology; D014945:Wound Healing / Q000502:physiology