Alcohol withdrawal is associated with poorer outcome in acute ischemic stroke

Analysis of severity in ischemic stroke patients with coronary artery disease in the telestroke network

Aim: This study investigated demographic and clinical risk factors associated with severity in acute ischemic stroke (AIS) patients with a history of coronary artery disease (CAD). Materials & methods: Multivariate logistic regression models were used to determine specific factors associated with worsening or improving neurologic functions among AIS patients with CAD treated in the telestroke. Results: AIS patients with CAD, peripheral vascular disease (OR: 3.995; 95% CI: 1.035-15.413; p = 0.044) and hypertension (OR: 6.056; 95% CI: 1.207-30.374; p = 0.029) were associated with worsening neurologic functions. Conclusion: Our findings suggest the need to develop strategic management to improve the care of AIS patients with a history of CAD that present with hypertension and peripheral vascular disease in the telestroke network.

Alcohol Withdrawal Is Associated With Worse Outcomes in Patients Undergoing Primary Total Knee or Total Hip Arthroplasty

BACKGROUND

Alcohol withdrawal (AW) syndrome is an independent risk factor for postoperative complications. This study aims to evaluate the influence of AW on perioperative outcomes in patients who underwent primary total knee (TKA) or total hip arthroplasty (THA).

METHODS

We used the National Inpatient Sample database to identify patients undergoing TKA/THA from 2003 to 2014. The primary exposure of interest was AW. Multivariable adjusted models were used to evaluate the association of AW with in-hospital medical complications, surgical complications, mortality, cost, and length of stay (LOS) in patients undergoing TKA/THA.

RESULTS

There were 2,971,539 adult hospitalizations for THAs and 6,367,713 hospitalizations for TKAs included in the present study, among which 0.14% of AW for THA patients and 0.10% of AW for TKA patients. Multivariable adjustment analysis suggested that AW was associated with an increased risk of medical complications (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.79-2.42, P < .0001), surgical complications (OR 1.75, 95% CI 1.51-2.03, P < .0001), and had 4.79 times increase of in-hospital mortality, 26% increase of total cost, and 53% increase of LOS in THA procedures. For TKA procedures, AW was also associated with increased risk of medical complications (OR 3.14, 95% CI 2.78-3.56, P < .0001), surgical complications (OR 2.07, 95% CI 1.82-2.34, P < .0001) and 4.24 times increase of in-hospital mortality, 29% increase of total cost, and 58% increase of LOS after multivariable adjustment.

CONCLUSION

AW is associated with increased risk of in-hospital mortality, medical and surgical complications. Proactive surveillance and management of AW may be important in improving outcomes in patients who underwent THA and TKA procedure.

Alcohol Abuse and Alcohol Withdrawal Are Associated with Adverse Perioperative Outcomes Following Elective Spine Fusion Surgery

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

Alcohol abuse (AA) and alcohol withdrawal (AW), both belonging to alcohol use disorders, bring about vast health consequences, social issues, and financial burden in United States. This study aims to explore the relationship of AA and AW with perioperative outcomes following elective spine fusion surgery.

SUMMARY OF BACKGROUND DATA

Large studies evaluating the outcomes of spine surgery in patients with AA or AW are lacking.

METHODS

We used the National Inpatient Sample (NIS) from 2006 to 2014 to extract records with a primary procedure of spinal fusion surgery. Multivariable regression analysis was used to assess the association of AA and AW with in-hospital mortality, perioperative complications, cost and length of stay (LOS).

RESULTS

Among 3,132,192 patients undergoing elective spinal fusion surgery, the prevalence of AA and AW was 1.14% (35,833) and 0.15% (4623), respectively. Among the AA admissions, 12.90% of patients developed AW. The incidence of overall complications was 6.14%, 10.15%, and 33.73% in patients without AA, with AA and with AW, respectively. After multivariable adjustment, AW was associated with elevated risk of overall complications (odds ratio [OR]: 4.51; 95% confidence interval [CI]: 3.86-5.27), neurologic (OR: 2.58; 95% CI: 1.62-4.12), respiratory (OR: 8.04; 95% CI: 6.62-9.77), cardiac (OR: 3.58; 95% CI: 2.60-4.93), gastrointestinal (OR: 2.31; 95%CI: 1.68-3.17), urinary and renal (OR: 2.68; 95% CI: 2.11-3.39), venous thromboembolism (OR: 3.06; 95% CI: 1.94-4.82), wound-related complications (OR: 3.84; 95% CI: 2.96-4.98) and in-hospital mortality (OR: 5.95; 95% CI: 3.25-10.90). AW was also linked to 40% higher cost and 85% longer LOS.

CONCLUSION

Both AA and AW are associated with adverse outcomes in patients undergoing spinal fusion surgery with more pronounced risks for AW. Aggressive management in perioperative period is required to improve outcomes in these patients.Level of Evidence: 3.