Tønnesen H et al. Alcohol abuse and postoperative morbidity. Danish Medical Bulletin 2003,50(2):139–160

“Haemostasis normalises after one to four weeks, cardiac function after one month, immune function after two months, and response to external stress after three months. ”

Preoperative alcohol cessation prior to elective surgery.

Citation: Cochrane Database of Systematic Reviews, 2012, vol./is. /7(0-0), 1469493X

Author(s): Oppedal K, Møller AM, Pedersen B, Tønnesen H

Abstract: Hazardous drinking has been associated with an increased postoperative complication rate after surgery. Common complications include postoperative infections, cardiopulmonary complications, and bleeding episodes. Preoperative abstinence may to some degree reverse alcohol-induced pathophysiological processes and thus prevent postoperative complications. To assess the effect of preoperative alcohol cessation interventions on the rate of postoperative complications including mortality in hazardous drinkers. To assess the effect of preoperative alcohol cessation interventions for hazardous drinkers on alcohol use in the postoperative period and in the long term. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 9); Ovid MEDLINE (1966 to September 2011); Ovid EMBASE (1966 to September 2011); CINAHL via EBSCOhost (1982 to September 2011). We combined the MEDLINE search strategy with the Cochrane highly sensitive search strategy, as contained in the Cochrane Handbook for Systematic Reviews of Interventions, to identify randomized controlled trials (RCTs). We included all randomized controlled trials (RCTs) that evaluated the effects of a preoperative alcohol cessation intervention on postoperative complications or postoperative alcohol consumption, or both, in the short and long term in hazardous drinkers . We excluded intraoperative and postoperative alcohol interventions. Three authors independently assessed studies to determine eligibility and extracted data using a tool based on guidance in the Cochrane Handbook for Systematic Reviews of Interventions. Where required, we obtained additional information through collaboration with the original author. We presented the main outcomes as dichotomous variables. Where data were available, we planned to conduct subgroup analyses as well as a sensitivity analysis to explore risk of bias. We included two studies which involved 69 patients. Both studies were RCTs evaluating the effect of intensive alcohol cessation interventions including pharmacological strategies for alcohol withdrawal and relapse prophylaxis.Our primary outcome measure was postoperative complications and in-hospital and 30-day mortality. Meta-analysis showed an effect on the overall complication rates (odds ratio (OR) 0.22; 95% confidence interval (CI) 0.08 to 0.61; P = 0.004). There was no significant reduction of in-hospital and 30-day mortality (OR 0.39; 95% CI 0.06 to 2.83; P = 0.35).Secondary outcomes included length of stay and postoperative alcohol use. No significant reduction was found. Based on the finding of two studies, it appears that intensive preoperative alcohol cessation interventions, including pharmacological strategies for relapse prophylaxis and withdrawal symptoms, may significantly reduce postoperative complication rates. No effect was found on mortality rates and length of stay.The effect of preoperative alcohol cessation intervention should be further explored in an effort to reduce the adverse effect of alcohol use on surgical outcomes. The number needed to screen to identify eligible patients for alcohol intervention studies in surgical settings seems to be extremely high. This may indicate that these studies are difficult to perform. Nevertheless, timing, duration and intensity of alcohol cessation interventions need to be subject to further investigation.[CINAHL Note: The Cochrane Collaboration systematic reviews contain interactive software that allows various calculations in the MetaView.]


Perioperative smoking and alcohol intervention in relation to radical cystectomy: Effect on postoperative complications and quality of life

Citation: Asia-Pacific Journal of Clinical Oncology, December 2014, vol./is. 10/(254), 1743-7555 (December 2014)

Author(s): Thomsen T.T.T., Lauridsen S.S.V.L.V., Thind P.P.T., Tonnesen H.H.T.

Abstract: Background: Daily smoking and alcohol consumption exceeding 2 units per day increase the risk of postoperative complications, lifestyle-related morbidity and recurrence of cancer disease. Evidence indicates that smoking and alcohol cessation intervention lasting 4 weeks and more reduces the frequency of postoperative complications and increases long-term lifestyle change. Patients suffering from cancer are however scheduled for surgery within maximum 2 weeks of diagnosis. Preoperative intervention lasting 4 weeks or more is therefore not possible for these patients. Intervention initiated immediately before and continued at least 5 weeks postoperatively may hypothetically be equally effective. Aim: To examine the effect of an intensive smoking and/or alcohol intervention initiated immediately before and continued 5 weeks after radical cystectomy versus standard preoperative care on postoperative complications, lifestyle change and quality of life up to 12 months postoperatively. Methods: A single-blinded randomized controlled trial. Primary outcome: postoperative complications up to 90 days postoperatively assessed according to the Clavien-Dindo classification. Secondary outcomes: smoking and/or alcohol cessation, length of hospital stay, time to return to work, quality of life. Inclusion criteria: Patients scheduled for radical cystectomy, aged 18 years and above, who are daily smokers and/or drink more than 3 units of alcohol daily. The intervention includes behavioral counseling with trained cessation counselors and pharmacological support to stop smoking and/or drinking perioperatively. Patients are invited to attend 5 individual meetings over 6 weeks. The first meeting occurs shortly before surgery and the remaining meetings are scheduled postoperatively. Data analysis using non-parametric statistics and intention to treat analysis. Results: The study is ongoing. We plan to present preliminary feasibility results (inclusion rate, patient compliance, lifestyle changes short-term) at the World Cancer Congress. Conclusions: If effective for preventing postoperative complications and increasing smoking and alcohol cessation, the intervention may impact on quality of life in cancer survivors.