title: Impact of an alcohol withdrawal syndrome practice guideline on surgical patient outcomes.
abstract: OBJECTIVE
  To standardize treatment of alcohol withdrawal syndrome (AWS) in surgical patients using an AWS practice guideline with a symptom-triggered approach.
  
  
  METHODS
  Prospective interventional (pilot group) and retrospective (comparison group).
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Thirty-eight trauma, orthopedic, and general surgery patients identified at risk for AWS in the pilot group, and 34 patients who were managed using nonstandardized approaches.
  
  
  METHODS
  At-risk patients in the pilot group were assessed using the AWS Type Indicator. They received lorazepam, clonidine, or haloperidol, based on AWS Type Indicator assessment and AWS practice guideline criteria.
  
  
  RESULTS
  A standardized symptom-triggered approach to managing AWS was expected to decrease the use of benzodiazepines, avoid undertreatment of adrenergic hyperactivity and delirium, decrease the need for sitters and physical restraints, and reduce hospital length of stay. Pilot patients received a mean of 23 mg less benzodiazepine (p=0.01), 0.1 mg more clonidine (p=0.01), and 20 mg less haloperidol (p=0.06) than comparison patients. Pilot patients also required significantly fewer sitter hours (p=0.04) and hours of restraint use (p=0.09) than comparison patients. No significant differences were found between groups for length of stay (p=0.77).
  
  
  CONCLUSIONS
  This pilot project suggests that trauma, orthopedic, and general surgery patients at risk for AWS can be safely and effectively managed with a standardized, symptom-triggered approach. Moreover, this approach decreased the amounts of benzodiazepines and haloperidol administered to patients at risk for AWS.
authors.affiliation: Department of Therapeutic Services, Medical University of South Carolina, Charleston 29425, USA. stanleyk@musc.edu
authors.forename: Karen M
authors.initials: KM
authors.lastname: Stanley
authors.forename: Celene M
authors.initials: CM
authors.lastname: Amabile
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
authors.forename: Deborah
authors.initials: D
authors.lastname: Couillard
authors.forename: E Douglas
authors.initials: ED
authors.lastname: Norcross
authors.forename: Cathy L
authors.initials: CL
authors.lastname: Worrall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000150:complications; D003000:Clonidine / Q000008:administration & dosage / Q000627:therapeutic use; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D008140:Lorazepam / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012149:Restraint, Physical; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D013514:Surgical Procedures, Operative
chemical_list: D000431:Ethanol; D006220:Haloperidol; D003000:Clonidine; D008140:Lorazepam