Alcohol withdrawal syndrome linked to worse surgical outcomes, higher costs

Key Takeaways

• Among 3 million surgical patients, 0.5% developed alcohol withdrawal syndrome (AWS), with 0.2% experiencing severe delirium tremens (DT). 
• AWS was associated with a 37% higher risk of complications, including respiratory failure and sepsis, and a 40% increased mortality risk if DT occurred.
• Hospital stays were 5 days longer, and costs rose by $10,000 per patient with AWS, totaling $165 million in excess costs nationwide. 

CHICAGO — Patients who develop alcohol withdrawal syndrome (AWS) after major surgery face significantly higher risks of complications, longer hospital stays, and increased health care costs, according to a study published in the Journal of the American College of Surgeons (JACS). The findings underscore the need for screening before surgery and targeted interventions. 

Using the National Inpatient Sample (2016–2019), researchers analyzed data from 3 million adults who underwent major operations, including colectomy, cardiac surgery, and liver resection. Among them, 16,504 (0.5%) were diagnosed with AWS, including 6,591 (0.2%) with life-threatening delirium tremens (DT). DT is a severe form of alcohol withdrawal that can include shaking, confusion, and hallucinations. 

“AWS is a preventable complication, yet it’s often overlooked in surgical planning,” said lead author Timothy M. Pawlik, MD, PhD, MPH, FACS, surgeon-in-chief at the Ohio State University Wexner Medical Center. “Our study shows that proactive screening and multidisciplinary care — involving surgeons, social workers, and addiction specialists — can save lives and reduce costs.” 

Key Findings  

• High-risk patients: AWS was more common in men (median age 61), Medicaid recipients, and those with substance use disorders.
• Complications: AWS doubled the risk of respiratory failure and sepsis. DT increased mortality by 40%.
• Economic impact: Adjusted hospitalization costs rose by $10,030 per patient with AWS; DT added another $5,300.  

Interventions for the Future 

The study highlights actionable strategies to improve outcomes:

1. Preoperative screening: Use validated tools (e.g., AUDIT-C) to identify high-risk patients.
2. Judgment-free care: “This is a disease, not a moral failing,” stressed Dr. Pawlik. “We need honest conversations to tailor treatment.”
3. Early intervention: For patients at risk, preventative medications (e.g., benzodiazepines) and ICU-level monitoring may prevent DT. 

“A patient recovering from major surgery shouldn’t also battle withdrawal,” said Dr. Pawlik, recalling a case where AWS led to aspiration pneumonia post-surgery. “We can change this by addressing alcohol use before surgery and ensuring safer recovery environments.” 

Limtations: The study relied on administrative data, potentially underestimating AWS incidence. Long-term outcomes and treatment specifics (e.g., benzodiazepine use) were not assessed. 

Coauthors are Azza Sarfraz, MBBS; Areesh Mevawalla MD; Abdullah Altaf, MD; Mujtaba Khalil, MD; Zayed Rashid, MD; Shahzaib Zindani MD 

The study is published as an article in press on the JACS website.  

Citation: Nationwide Trends and Perioperative Outcomes of Alcohol Withdrawal Syndrome After Major Operation. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000001487 

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 90,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons.