Abstract: | ObjectiveTo evaluate the influence of preoperative abstinence on postoperative outcome in alcohol misusers with no symptoms who were drinking the equivalent of at least 60 g ethanol/day. DesignRandomised controlled trial.SettingCopenhagen, Denmark.Subjects42 alcoholic patients without liver disease admitted for elective colorectal surgery.InterventionsWithdrawal from alcohol consumption for 1 month before operation (disulfiram controlled) compared with continuous drinking.ResultsThe intervention group developed significantly fewer postoperative complications than the continuous drinkers (31% v 74%, P=0.02). Delayed type hypersensitivity responses were better in the intervention group before (37 mm2 v 12 mm2, P=0.04), but not after surgery (3 mm2 v 3 mm2). Development of postoperative myocardial ischaemia (23% v 85%) and arrhythmias (33% v 86%) on the second postoperative day as well as nightly hypoxaemic episodes (4 v 18 on the second postoperative night) occurred significantly less often in the intervention group. Surgical stress responses were lower in the intervention group (P⩽0.05).ConclusionsOne month of preoperative abstinence reduces postoperative morbidity in alcohol abusers. The mechanism is probably reduced preclinical organ dysfunction and reduction of the exaggerated response to surgical stress. Key messages- Recent data have shown alcohol misusers to have a threefold increase in postoperative morbidity
- In misusers recovery from organ dysfunction induced by alcohol is seen after abstinence
- Abstinence from alcohol for 1 month before surgery reduces postoperative morbidity after colorectal surgery
- Mechanisms may involve reduced responses to surgical stress and improved cardiac and immune dysfunction
- Withdrawal from alcohol before an operation is recommended in alcohol abusers
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