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Alcohol Misuse Is Associated With An Increased Risk Of Postoperative Complication, Length Of Stay And Hospital Charges For Patients Undergoing Major Foregut Resection
*Sujay Kulshrestha1, *Corinne Bunn1, *Majid Afshar1, Marshall S Baker2
1Loyola University Medical Center, Maywood, IL;2Edward Hines Jr. Veterans Administration Hospital, Hines, IL

OBJECTIVE(S): Major foregut resections carry risk of significant postoperative morbidity. Few studies evaluate the impact of substance misuse on incident rates and severity of these complications.
METHODS: The National Inpatient Sample (NIS) was queried to identify patients undergoing total gastrectomy, esophagectomy, and pancreaticoduodenectomy between 2012 and 2015. Substance misuse was assessed by ICD-9 code and NIS coder designations. Multivariable regression (MVR) was used to identify associations between substance misuse, demographics, disease comorbidities and complication rates, 90-day mortality, hospital length of stay including readmissions to 90 days (LOS) and total inpatient charges.
RESULTS: 12,191 patients met inclusion criteria; 418 (3.4%) had alcohol misuse; 259 (2.1%) drug misuse (2.1%). Alcohol and drug misusers were more likely to be male (80.4% and 62.9% vs 57.1%, p <0.001) and to be on Medicaid (19.6% and 14.7% vs 7.3%, p < 0.001) than non-misusers. On univariate analysis, alcohol misusers had higher rates of postoperative complication (withdrawal (18.7% vs 0%, p <0.001), pneumonia (11.2%vs. 6.9%, p <0.01), respiratory failure (27.8% vs 16.6%, p <0.01), sepsis (12.9% vs 8.1%, p = 0.001) and shock (19.6% versus 13.1%, p = 0.001)), greater mean LOS (16.60 vs 13.92 days, p < 0.001) and higher average charges ($215,456 and $175,381, p <0.001) than non-misusers. On MVR adjusted for age, sex, insurance type, income status, and comorbid conditions, alcohol misuse was associated with a 50% increase in the odds risk of postoperative complication (OR 1.50 [1.21, 1.86], p <0.05) and significant increases in LOS (+1.63 days [0.44, 2.81], p = 0.007) and charges (+$24112 [$4627, $43597], p = 0.015) but not in mortality (OR 0.97 [0.55, 1.59], p = 0.899). Illicit drug misusers had a noted risk of withdrawal (4.6% vs. 0.0%, p<0.001) on univariate analysis but demonstrated no significant difference relative to non-misusers in complication rate, LOS and charges on MVR.
CONCLUSIONS: Patients undergoing major foregut resection with a significant active alcohol misuse are at increased risk for postoperative complication, prolonged length of stay and added costs of care. Efforts at screening for alcoholism and abstinence intervention should be incorporated into the preoperative care pathways for these patients.


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