Alcohol Disorders Increase Mortality, Cost, Length of Stay
Worcester, Sharon, Clinical Psychiatry News
Patients with alcohol use disorders who develop health care-associated infections have a 71% greater mortality risk, as well as longer hospital stays and higher hospital costs, than do those without alcohol use disorders who develop such infections, according to an analysis of data from a large inpatient database.
The researchers studied the more than 32.7 million hospital discharges in the Nationwide Inpatient Sample for 2007, of which 149,982 developed a health care-associated infection and met inclusion criteria for the study. From the overall group, 4.7% were patients with an alcohol use disorder (AUD), while 5.9% of the cohort with a health care-associated infection also had an AUD codiagnosis, the researchers wrote. Having an AUD was found to be an independent predictor of increased mortality in the latter group (odds ratio 1.71), reported Dr. Marjolein de Wit of Virginia Commonwealth University, Richmond, and her colleagues.
An AUD diagnosis was also found to be an independent predictor of a 2-day increase in hospital length of stay (13 days in those with an AUD vs. 11 days in those without). Hospital costs were about $7,500 higher ($34,826 vs. $27,167) for those AUD patients (Alcohol. Clin. Exp. Res. 2011 April 15 [doi: 10. 1111 / j 1530-0277.2011. 01475.x]).
Studies have shown that the increased risk of health care infections in this population might be explained by cytokine abnormalities, impaired cell-mediated immune function, and aberrant innate immunity they noted. "Studies evaluating therapies aimed at decreasing the risk of developing health care-associated infections in patients with AUD are warranted."
In the meantime, steps can be taken to reduce risk of developing health care-associated infections, according to Dr. Claudia Spies, of University Hospital Charite Universitaetsmedizin Berlin, whose earlier research was cited in the current study.
In a statement on the findings, Dr. Spies noted the importance of external measures such as hand washing and head-of-bed elevation, and of the need for intrinsic measures such as therapeutic interventions specifically targeting hospitalized patients with AUDs. AUDs are factors intrinsic to patients, so preventing health care-associated infections in these patients requires such interventions, she said.
Dr. Spies and Dr. de Wit emphasized the need for candid discussion about alcohol use - despite the stigma patients may feel.
"This is important both when a hospital admission is scheduled as well as at the time of an emergency hospital admission. In the case with scheduled surgeries, such as an elective surgery, 1 month preoperative abstinence may decrease the risk of health care-associated infections," Dr. …