Long-term alcoholics are known to have a greater risk of disease anddeath following surgery.A new study examines the risk of infection following elective cardiacsurgery.
Results show that long-term alcoholics have a four-fold increased rateof postoperative infections, an increased length of need for mechanicalventilation, as well as a need for prolonged treatment in the intensivecare unit.
Previous research has shown that post-surgery rates of disease anddeath are two-to-five times greater among long-term alcoholics thannonalcoholic patients. Of all the possible complications, infection canbe the most serious. A study in the September issue of Alcoholism: Clinical & Experimental Researchfinds that long-term alcoholics are at a higher risk for postoperativeinfections following elective cardiac surgery than nonalcoholicpatients are.
"Other studies have shown that 20 to 30 percent of allpatients admitted to a hospital are alcohol abusers," said MichaelSander, a researcher at Charité Hospital at the University of Berlinand corresponding author for the study. "The highest prevalence of thisabuse is detected in the third to fifth decade of life. We also knowthat surgical complications can increase with the daily intake of 60grams, which is about three glasses of beer or wine."
Alcohol is a drug, added Jan-Philipp Breuer, also a researcherat Charité Hospital at the University of Berlin. "And whether a drug isgood or bad for you and your body depends – as is the case with alldrugs – on the dose. You may treat your hypertension with beta-blockersto 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 ofalcohol, such as one glass of red wine per day, to prevent myocardialinfarction … but three bottles of beer per day has been proven to harmthe body. In particular, it weakens the immune system, which everyoperative patient needs in order to fight postoperative infections."
Sander also noted that the hospital costs of alcohol-relatedcomplications can be considerable. "If we estimate a cost of $2,000 inU.S. dollars (USD) per day for intensive-care treatment, a prolongedstay of five days at $10,000 USD per patient can quickly add up."
Researchers examined 44 patients undergoing elective cardiacsurgery: 10 long-term alcoholics (9 males, 1 female), and 34nonalcoholics (27 males, 7 females). All of the patients' health anddrinking histories were obtained prior to surgery. Blood samples forimmune-status analysis – specifically, levels of TNF-alpha,interleukin-6, interleukin-10 and cortisol – were obtained uponadmission to the hospital, the morning before surgery, on admission tothe ICU, and the mornings of days one and three following surgery.
The results show that long-term alcoholics have a four-foldincreased rate of postoperative infections, an increased length of needfor mechanical ventilation, as well as a need for prolonged treatmentin the intensive care unit (ICU). More specifically, long-termalcoholics showed a distinct increase in their cortisol andinterleukin-10 levels following cardiopulmonary bypass surgery. Therewas one death in the long-term alcoholic group, and two deaths in thenonalcoholic group.
"A key consideration here is that long-term alcoholics have pretty well-defined immune alterations priorto clinically evident infections," said Sander. "We believe that thesealterations might be responsible for the postoperative increasedinfection rate observed in our study and in others. We believe thatpre- and perioperative immune-modulating treatments might be able todecrease the infection rate as well as the prolonged ICU stay.Researchers should embark on studies aimed at immune-modulationtherapies in these high-risk patients."
Both Sander and Breuer said that these findings may help tomotivate the average reader to think about their daily alcoholconsumption levels.
"Everybody, sooner or later, will likely have an operation forone reason or another," said Breuer. "How much an individual drinks ona daily basis may have a significant impact on his or her recovery."
Alcoholism: Clinical & Experimental Research (ACER) isthe official journal of the Research Society on Alcoholism and theInternational Society for Biomedical Research on Alcoholism. Co-authorsof the ACER paper, "Increased Interleukin-10 and Cortisol in Long-termAlcoholics after Cardiopulmonary Bypass – A Hint to the IncreasedPostoperative Infection Rate?," were: Christian von Heymann, TimNeumann, Jan P. Braun, Marc Kastrup, and Claudia D. Spies of theDepartments of Anesthesiology and Intensive Care; and Sven Beholz andWolfgang Konertz of Cardiovascular Surgery – all of the CharitéUniversity Hospital on the Campus Charité Mitte at the University ofMedicine in Berlin. The study was funded by the Charité Medical School.
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