Long-term alcoholics are known to have a greater risk of disease and death following surgery. A new study examines the risk of infection following elective cardiac surgery.
Results show that long-term alcoholics have a four-fold increased rate of postoperative infections, an increased length of need for mechanical ventilation, as well as a need for prolonged treatment in the intensive care unit.
Previous research has shown that post-surgery rates of disease and death are two-to-five times greater among long-term alcoholics than nonalcoholic patients. Of all the possible complications, infection can be the most serious. A study in the September issue of Alcoholism: Clinical & Experimental Research finds that long-term alcoholics are at a higher risk for postoperative infections following elective cardiac surgery than nonalcoholic patients are.
"Other studies have shown that 20 to 30 percent of all patients admitted to a hospital are alcohol abusers," said Michael Sander, a researcher at Charité Hospital at the University of Berlin and corresponding author for the study. "The highest prevalence of this abuse is detected in the third to fifth decade of life. We also know that surgical complications can increase with the daily intake of 60 grams, which is about three glasses of beer or wine."
Alcohol is a drug, added Jan-Philipp Breuer, also a researcher at Charité Hospital at the University of Berlin. "And whether a drug is good or bad for you and your body depends – as is the case with all drugs – on the dose. You may treat your hypertension with beta-blockers to feel better, or you may kill yourself with them in an act of suicide – it's all a matter of dose. Researchers recommend a low dose of alcohol, such as one glass of red wine per day, to prevent myocardial infarction … but three bottles of beer per day has been proven to harm the body. In particular, it weakens the immune system, which every operative patient needs in order to fight postoperative infections."
Sander also noted that the hospital costs of alcohol-related complications can be considerable. "If we estimate a cost of $2,000 in U.S. dollars (USD) per day for intensive-care treatment, a prolonged stay of five days at $10,000 USD per patient can quickly add up."
Researchers examined 44 patients undergoing elective cardiac surgery: 10 long-term alcoholics (9 males, 1 female), and 34 nonalcoholics (27 males, 7 females). All of the patients' health and drinking histories were obtained prior to surgery. Blood samples for immune-status analysis – specifically, levels of TNF-alpha, interleukin-6, interleukin-10 and cortisol – were obtained upon admission to the hospital, the morning before surgery, on admission to the ICU, and the mornings of days one and three following surgery.
The results show that long-term alcoholics have a four-fold increased rate of postoperative infections, an increased length of need for mechanical ventilation, as well as a need for prolonged treatment in the intensive care unit (ICU). More specifically, long-term alcoholics showed a distinct increase in their cortisol and interleukin-10 levels following cardiopulmonary bypass surgery. There was one death in the long-term alcoholic group, and two deaths in the nonalcoholic group.
"A key consideration here is that long-term alcoholics have pretty well-defined immune alterations prior to clinically evident infections," said Sander. "We believe that these alterations might be responsible for the postoperative increased infection rate observed in our study and in others. We believe that pre- and perioperative immune-modulating treatments might be able to decrease the infection rate as well as the prolonged ICU stay. Researchers should embark on studies aimed at immune-modulation therapies in these high-risk patients."
Both Sander and Breuer said that these findings may help to motivate the average reader to think about their daily alcohol consumption levels.
"Everybody, sooner or later, will likely have an operation for one reason or another," said Breuer. "How much an individual drinks on a daily basis may have a significant impact on his or her recovery."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Increased Interleukin-10 and Cortisol in Long-term Alcoholics after Cardiopulmonary Bypass – A Hint to the Increased Postoperative Infection Rate?," were: Christian von Heymann, Tim Neumann, Jan P. Braun, Marc Kastrup, and Claudia D. Spies of the Departments of Anesthesiology and Intensive Care; and Sven Beholz and Wolfgang Konertz of Cardiovascular Surgery – all of the Charité University Hospital on the Campus Charité Mitte at the University of Medicine in Berlin. The study was funded by the Charité Medical School.
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