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Program Number: B278
Session Name: Poster Session

Alcohol Withdrawal After Head and Neck Free Flap Surgery: Risk Factors and Outcomes

Eric Nisenbaum, MD, MSc¹; Madeline Pyle, MD²; Mark Wax, MD³; Joseph Curry⁴; Carissa Thomas, MD, PhD⁵; Sallie Long, MD⁶; Dev Amin⁴; Caroline Bonaventure, MD⁷; Farshid Taghizadeh, MD³; Dina Modlin, BS²; Jason Leibowitz, MD²; Michael DiLeo, MD⁷; Nicolaus Knight, MS⁵; Elise Krippaehne, BS³; Javier Nishikawa, BS⁵; Yasaman Baghshomali, PhD, MSc⁸; Madeline Otto³; Sruti Tekumalla, BA⁴; Sumanth Chandrupatla⁵; Larissa Sweeny, MD²; ¹The Ohio State University Wexner Medical Center Department of Otolaryngology - Head and Neck Surgery; ²University of Miami Department of Otolaryngology - Head and Neck Surgery; ³Oregon Health and Science University Department of Otolaryngology - Head and Neck Surgery; ⁴Thomas Jefferson University Department of Otolaryngology - Head and Neck Surgery; ⁵University of Alabama at Birmingham Department of Otolaryngology - Head and Neck Surgery; ⁶Medical College of Georgia Department of Otolaryngology - Head and Neck Surgery; ⁷Louisiana State University Health Science Center Department of Otolaryngology - Head and Neck Surgery; ⁸University of Colorado School of Medicine

Background: Alcohol use and abuse is highly prevalent in the head and neck cancer patient population.  Patients undergoing head and neck free flap surgery are at risk for developing alcohol withdrawal in the immediate postoperative period, which can be associated with significant morbidity including delirium and seizures.  There is a lack of information in the literature regarding factors that may contribute to developing withdrawal, as well as regarding the effects of withdrawal on postoperative outcomes.  In this study, we sought to 1) identify demographic and surgical factors associated with developing alcohol withdrawal after head and neck free flap surgery, and 2) to investigate the association between post-operative withdrawal, post-operative complications, and overall post-operative course.

Methods: Multi-institutional retrospective cohort study. Consecutive patients undergoing head and neck microvascular reconstruction at four tertiary care institutions between 2010 and 2021 were included (N=2224).  Demographic, preoperative, operative, and postoperative variables were collected and correlated with both alcohol use and development of alcohol withdrawal using multiple statistical methods.

Results: 82 of 2224 (3.7%) patients developed alcohol withdrawal postoperatively. Lower preoperative BMI (22.4 vs 25.8, p<0.0001) and albumin level (3.1 vs 3.3, p=0.031) were associated with developing withdrawal.  There was no association between operative factors and withdrawal. 

Development of withdrawal was associated with higher rates of postoperative medical complications (33.3% vs 13.2%, p<0.0001), wound dehiscence (25.9% vs 12.2%, p=0.0009), delirium (65.9% vs 2.3%, p<0.0001), and ICU bounce back (13.2% vs 4.1%, p=0.0015).  It was also associated with increased length of stay (14.0 vs 10.1 days, p=0.004) and likelihood of discharge to a non-home destination (32.5% vs 17.3%, p=0.0015).  None of these postoperative outcomes were associated with alcohol use alone.

Conclusion: Postoperative alcohol withdrawal occurs in a small but notable percentage of patients undergoing head and neck free flap surgery.  Poor preoperative nutritional status may increase the risk of developing withdrawal.  Withdrawal is associated with numerous postoperative complications which likely contribute to increased length of stay and the need for a higher level care after discharge.  A proactive approach to identifying and treating patients at high risk for withdrawal may improve postoperative outcomes. 

 

 

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