Impact of an alcohol withdrawal syndrome practice guideline on surgical patient outcomes.
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.
Stanley
Karen M
KM
Department of Therapeutic Services, Medical University of South Carolina, Charleston 29425, USA. stanleyk@musc.edu
Amabile
Celene M
CM
Simpson
Kit N
KN
Couillard
Deborah
D
Norcross
E Douglas
ED
Worrall
Cathy L
CL
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
D000431:Ethanol; D006220:Haloperidol; D003000:Clonidine; D008140:Lorazepam