The Impact of Alcohol Abuse on Multiple Organ Dysfunction in the Surgical Patient

Abstract

Individuals with an alcohol-use disorder (AUD) admitted to trauma and/or surgical services in hospital show a two- to fourfold higher rate of postoperative complications, leading to longer hospital stays and increased mortality. Chronic alcohol consumption damages the central and peripheral nerve system and can cause a severe state of physiological withdrawal called the "alcohol withdrawal syndrome" that when manifested during their management in the intensive care unit (ICU) is associated with more adverse outcomes, both in the ICU and after hospital discharge. Often unrecognized, decreased beta-endorphin levels in these individuals may cause their pain to be more pronounced. In parallel, the risk for cardiac complications including arrhythmias and circulatory insufficiency in the postoperative period is increased up to fivefold in individuals with an AUD. Further, alcohol-induced hepatic insufficiency when present leads to higher levels of toxic substances, including ammonia and lactic acid, and promotes insulin resistance and decreased cellular glucose uptake. In addition, disturbances in haemostasis, including decreased platelet function and impaired hepatic synthesis of coagulation factors, are associated with (if not causative of) a twofold increased risk of postoperative bleeding complications. Finally, alterations in the neuroendocrine axis and in the immune system result in a three- to fivefold increased risk of nosocomial infections including pneumonia, wound infections and urinary tract infections. As a result of these myriad pathophysiological mechanisms, surgical patients with an AUD require increased attention to promote a good response to treatment and to minimize their risk of developing multiple organ failure. (PsycINFO Database Record (c) 2016 APA, all rights reserved)