Saturday, June 29, 2013

How dry I am: alcohol consumption and postoperative complications - the second P

We've been blogging quite a bit about the 4Ps (the problem, the patient, the procedure and the provider), and especially the second P. The recent article, Preoperative Alcohol Consumption and Postoperative Complications: A Systematic Review and Meta-analysis. is another about the second P as well.

The authors systematically reviewed the evidence of the association between preoperative alcohol consumption and postoperative complications within the first 30 days. They found that preoperative alcohol consumption was associated with an increased risk of various postoperative complications, including morbidity, infections, wound complications,  pulmonary complication, prolonged stay at the hospital, and admission to intensive care unit.  High alcohol consumption was associated with increased risk of postoperative mortality.

This article reminds us again to consider the overall condition of the patient when contemplating surgery. It suggests that, for example, a total shoulder in for an arthritic shoulder in a heavy drinking patient is likely to have a different outcome than a total shoulder in for the same type of arthritic shoulder in a more healthy individual.

These authors measured alcohol consumption in terms of g/day. High alcohol consumption was defined as consuming more than 24 g/d for women and 36 g/d for men. For those unfamiliar with this unit of measure, there are 750ml in a bottle of wine. If the bottle is 13% alcohol by volume, then there is 98ml alcohol per bottle. Alcohol’s specific gravity is .79, so there are 77g alcohol in a bottle. Another way of looking at it is that the standard portion sizes are 341 mL for beer, 150 mL for wine, and 45 mL for spirits. The alcohol intake per portion is 13.7 g for beer, 13.3 g for wine, and 14.2 g for spirits.

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