Association between alcohol use disorder and hospital outcomes in colectomy patients - A retrospective cohort study

Megan L Rolfzen; Susan K Mikulich-Gilbertson; Crystal Natvig; Jacqueline A Carrico; Robert L Lobato; Martin Krause; Karsten Bartels

doi:10.1016/j.jclinane.2022.110674

Association between alcohol use disorder and hospital outcomes in colectomy patients - A retrospective cohort study

J Clin Anesth. 2022 Jun:78:110674. doi: 10.1016/j.jclinane.2022.110674. Epub 2022 Feb 12.

Authors

Megan L Rolfzen¹, Susan K Mikulich-Gilbertson², Crystal Natvig², Jacqueline A Carrico³, Robert L Lobato¹, Martin Krause⁴, Karsten Bartels⁵

Affiliations

¹ Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA.
² Department of Psychiatry, University of Colorado, School of Medicine, Aurora, CO, USA.
³ Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.
⁴ Department of Anesthesiology, University of California, San Diego, CA, USA.
⁵ Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA; Outcomes Research Consortium, Cleveland, OH, USA. Electronic address: karbartels@unmc.edu.

PMID: 35168136
DOI: 10.1016/j.jclinane.2022.110674

Abstract

Study objective: In the United States, alcohol use disorder adversely affects 5.6% of all adults. Excessive alcohol consumption adversely affects organ functions critical for adaptation to stress induced by surgery. Colorectal resection is one of the most common major surgeries in patients at risk for alcohol use disorder. The objective of this study was to assess the impact of alcohol use disorder on hospital outcomes after colectomy using a population-based discharge database.

Setting: Population-based discharge database.

Patients: The Premier Healthcare Database was queried for the 603,730 adult patients who underwent colectomy from 2016 to 2019.

Interventions: None.

Measurements: Multiple logistic regressions estimated the associations between in-hospital mortality, length of stay, and hospitalization cost with alcohol use disorder as the primary predictor, adjusting for other substance use disorders, psychotic disorders, depression, other Elixhauser comorbidities, age, payor, race, gender, non-elective surgery, and other unbalanced variables.

Main results: A discharge code for alcohol use disorder was identified in 2.9% of colectomy patients and the overall in-hospital mortality rate in all sampled colectomy patients was 1.4%. Alcohol use disorder was associated with a significantly increased risk of in-hospital mortality after adjusting for other factors (AOR 1.36, 95% CI 1.24-1.48, p < 0.0001). Alcohol use disorder was also significantly associated with long length of stay (AOR 1.45, 95% CI 1.39-1.52, p < 0.0001) and high hospitalization costs (AOR 1.63, 95% CI 1.56-1.70, p < 0.0001).

Conclusions: Alcohol use disorder is associated with an increased risk of in-hospital mortality in patients undergoing colectomy, one of the most common major surgeries. Future research should examine if enhanced efforts to identify patients with alcohol use disorder could enable anesthesiologists to provide worthwhile perioperative interventions for this high-risk population.

Keywords: Alcohol use disorder; Colectomy; Depression; In-hospital mortality; Psychotic disorder; Substance use disorder.

MeSH terms

Adult
Alcohol Drinking
Alcoholism* / complications
Alcoholism* / epidemiology
Colectomy / adverse effects
Hospital Mortality
Hospitals
Humans
Length of Stay
Retrospective Studies
United States / epidemiology