Minor effect of patient education for alcohol cessation intervention on outcomes after acute fracture surgery: a randomized trial of 70 patients

Julie Weber Melchior Egholm; Bolette Pedersen; Kristian Oppedal; Bjørn Lindegård Madsen; Jes Bruun Lauritzen; Mette Rasmussen; Anders Helander; Johanna Adami; Hanne Tønnesen

doi:10.2340/17453674.2022.2482

Authors

Julie Weber Melchior Egholm Orthopaedic Department, Hospital of Southern Jutland, University of Southern Denmark, Aabenraa, Denmark; Clinical Health Promotion Centre, WHO-CC, the Parker Institute, Bispebjerg & Frederiksberg Hospital, Copenhagen University Hospitals, Denmark
Bolette Pedersen Clinical Health Promotion Centre, WHO-CC, the Parker Institute, Bispebjerg & Frederiksberg Hospital, Copenhagen University Hospitals, Denmark
Kristian Oppedal Alcohol and Drug Research Western Norway, Stavanger University Hospital, Norway
Bjørn Lindegård Madsen Orthopaedic Department, Amager & Hvidovre Hospital, Copenhagen University Hospitals, Denmark
Jes Bruun Lauritzen Orthopaedic Department, Bispebjerg & Frederiksberg Hospital, Copenhagen University Hospitals, Denmark
Mette Rasmussen Clinical Health Promotion Centre, WHO-CC, the Parker Institute, Bispebjerg & Frederiksberg Hospital, Copenhagen University Hospitals, Denmark; Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Lund, Sweden https://orcid.org/0000-0003-2847-1544
Anders Helander Department of Laboratory Medicine, Karolinska Institutet & Karolinska University Laboratory, Stockholm, Sweden https://orcid.org/0000-0001-7480-8078
Johanna Adami Sophiahemmet University, Stockholm, Sweden
Hanne Tønnesen Orthopaedic Department, Hospital of Southern Jutland, University of Southern Denmark, Aabenraa, Denmark; Clinical Health Promotion Centre, WHO-CC, the Parker Institute, Bispebjerg & Frederiksberg Hospital, Copenhagen University Hospitals, Denmark; Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Lund, Sweden

DOI:

https://doi.org/10.2340/17453674.2022.2482

Keywords:

alcohol intervention, ankle fracture, postoperative complications, surgery

Abstract

Background and purpose: High alcohol intake is associated with increased risk of postoperative complications. Alcohol cessation intervention is recommended prior to elective surgery. We investigated short- and long-term effects of perioperative intensive alcohol intervention in relation to acute ankle fracture surgery.

Patients and methods: 70 patients requiring ankle fracture surgery and consuming ≥ 21 drinks weekly (1 drink = 12 g ethanol) were randomized to a manual-based 6-week intensive standardized alcohol cessation program, the Gold Standard Program (GSP-A), or treatment as usual (TAU), on the day of operation. GSP-A included 5 personal meetings, patient education, and motivational and pharmacological support (alcohol withdrawal prophylaxis, B vitamins, and low-dose disulfiram). Complications requiring treatment
were measured after 6 weeks and 1 year. Alcohol intake was validated by biomarkers. Quality of life (QoL) was measured by the SF-36. Hospital costs were obtained from the National Hospital Costs Register.

Results: Postoperatively, complete alcohol cessation was higher in the GSP-A than in the TAU group (18/35 vs. 5/35, number needed to treat = 3, p ≤ 0.001), but not lowrisk consumption in the long term (10/35 vs. 7/33, p = 0.5). Number of complications in the short and long term (12/35 vs. 14/33, 16/35 vs. 18/33), the SF-36 score, or hospital costs in the short and long term (€6,294 vs. €8,024, €10,662 vs.
€12,198), were similar between the groups.

Interpretation: Despite an effect on alcohol cessation and a positive tendency as regards the other outcomes, the postoperative complications, QoL, and costs were similar. Better perioperative strategies for acute surgical patients with high alcohol intake therefore need to be developed.