title: Improved outcomes in patients with head and neck cancer using a standardized care protocol for postoperative alcohol withdrawal.
abstract: OBJECTIVE
  To show clinical benefit in the main outcome measures by the use of a standardized protocol for identification, characterization, and treatment of alcohol withdrawal syndrome (AWS) in postoperative patients with head and neck cancer.
  
  
  METHODS
  Prospective cohort study with a retrospective cohort control.
  
  
  METHODS
  Tertiary care university.
  
  
  METHODS
  A total of 26 consecutive postoperative patients with AWS were selected from among 652 patients with head and neck cancer to be enrolled in the protocol from March 2003 through March 2005. Controls consisted of 14 of 981 consecutive patients with AWS from March 2000 through December 2002.
  
  
  METHODS
  Application of a standardized care protocol.
  
  
  METHODS
  Sensitivity and specificity of preoperative screening for AWS risk, predictability of outcomes, length of stay, transfers to the intensive care unit (ICU), AWS symptoms, postoperative morbidity and mortality, doses of pharmacotherapy required, and charges.
  
  
  RESULTS
  Protocol patients demonstrated significantly fewer AWS-related ICU transfers and less delirium and violence than preprotocol patients. Mortality, wound complications, hospital charges, and doses of benzodiazepines, clonidine, and haloperidol were not significantly different between these 2 groups. Preoperative medical history correlated poorly with AWS outcomes. Screening was 87.5% sensitive and 99.7% specific. Late enrollees to the protocol (false-negative screening results) showed many significantly worse outcomes than immediate enrollees.
  
  
  CONCLUSIONS
  Use of the standardized AWS symptom-triggered protocol decreased delirium, violence, and AWS-related ICU transfers without significantly increasing hospital charges.
authors: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI 48109, USA.
authors: Christopher D
authors: CD
authors: Lansford
authors: Cathleen H
authors: CH
authors: Guerriero
authors: Mary J
authors: MJ
authors: Kocan
authors: Richard
authors: R
authors: Turley
authors: Michael W
authors: MW
authors: Groves
authors: Vinita
authors: V
authors: Bahl
authors: Paul
authors: P
authors: Abrahamse
authors: Carol R
authors: CR
authors: Bradford
authors: Douglas B
authors: DB
authors: Chepeha
authors: Jeffrey
authors: J
authors: Moyer
authors: Mark E
authors: ME
authors: Prince
authors: Gregory T
authors: GT
authors: Wolf
authors: Michelle L
authors: ML
authors: Aebersold
authors: Theodoros N
authors: TN
authors: Teknos
mesh_terms: D000328:Adult; D000368:Aged; D000430:Alcohol Withdrawal Delirium / Q000175:diagnosis / Q000534:rehabilitation; D000437:Alcoholism / Q000175:diagnosis / Q000534:rehabilitation*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D015331:Cohort Studies; D000431:Ethanol / Q000633:toxicity*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D011183:Postoperative Complications / Q000175:diagnosis / Q000534:rehabilitation*; D011446:Prospective Studies; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000534:rehabilitation*; D016896:Treatment Outcome
chemical_list: D000431:Ethanol