Alcoholism and Fractures: A Retrospective Study

Abstract

Background: Alcoholism is a significant risk factor in patients with extremity fractures that require surgery. Nearly half of the patients admitted to our hospital with fractures have either a history of significant alcohol use or positive blood alcohol concentration (BAC). These patients are at increased risk of morbidity and subsequent lengthened stays in the hospital and intensive care unit (ICU).
Methods: The importance of timing of surgery in the treatment of a patient with at least one extremity fracture and a positive BAC was analyzed by a chart-based review of their pre- and post-injury characteristics and post-surgical outcomes. Two patient groups were then organized with one group of patients undergoing surgery in the first 24 hours following admission and the second group undergoing surgery at a time later than the first 24 hours.
Results: The two patient groups had no significant difference forage, gender, admission BAC, or admission mean corpuscular volume (MCV). Patients that underwent surgery after the first 24 hours following admission were found to have a significantly greater injury severity score (ISS) than those undergoing surgery within the first 24 hours (16.14 ± 1.23 vs. 12.19 ± 0.657, p-value = 0.006). After controlling for ISS as a covariate, no significant difference was found for length of hospitalization for the two groups or for the occurrence of post-surgery related complications. Significant difference was found for length of stay in the ICU, with the group of patients who underwent delayed surgery staying longer.
Conclusion: Considering the morbidity and cost associated with post-surgical complications and increased lengths of stay in the hospital and ICU, patients with positive BAC and extremity fracture(s) should undergo surgery within the first 24 hours following admission.

Alcoholism - Fractures

References

• 1 Kuhn W, Bell R, Seligson D, Laufer S, Lindner J. The tip of the Iceberg: Psychiatric consultations on an orthopedic service.  Int J Psychiatry In Medicine. 1988;  18 375-382
• 2 Moore R, Bone L, Geller G, Mamon J, Stokes E, Levine D. Prevalence, detection, and treatment of alcoholism in hospitalized patients.  JAMA. 1989;  261 403-407
• 3 Spies C, Dubisz N, Funk W, Blum S, Müller C, Rommelspacher H, Brummer G, Specht M, Hannemann L, Striebel H, Schaffartzik W. Prophylaxis of alcohol withdrawal syndrome in alcohol-dependent patients admitted to the intensive care unit after tumour resection.  British Journal of Anaesthesia. 1995;  75 734-739
• 4 Spies C, Rommelspacher H. Alcohol withdrawal in the surgical patient: Prevention and treatment.  Anesthesia Analag. 1999;  88 946-954