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Christopher D. Lansford, MD; Cathleen H. Guerriero, RN, BSN; Mary J. Kocan, MSN; Richard Turley, MD; Michael W. Groves, MD; Vinita Bahl, DMD, MPP; Paul Abrahamse, MA; Carol R. Bradford, MD; Douglas B. Chepeha, MD; Jeffrey Moyer, MD; Mark E. Prince, MD; Gregory T. Wolf, MD; Michelle L. Aebersold, RN; Theodoros N. Teknos, MD

Arch Otolaryngol Head Neck Surg. 2008;134(8):865-872.

Objective  To show clinical benefit in the main outcome measures by the use of a standardized protocol for identification, characterization, and treatment of alcohol withdrawal syndrome (AWS) in postoperative patients with head and neck cancer.

Design  Prospective cohort study with a retrospective cohort control.

Setting  Tertiary care university.

Patients  A total of 26 consecutive postoperative patients with AWS were selected from among 652 patients with head and neck cancer to be enrolled in the protocol from March 2003 through March 2005. Controls consisted of 14 of 981 consecutive patients with AWS from March 2000 through December 2002.

Intervention  Application of a standardized care protocol.

Main Outcome Measures  Sensitivity and specificity of preoperative screening for AWS risk, predictability of outcomes, length of stay, transfers to the intensive care unit (ICU), AWS symptoms, postoperative morbidity and mortality, doses of pharmacotherapy required, and charges.

Results  Protocol patients demonstrated significantly fewer AWS-related ICU transfers and less delirium and violence than preprotocol patients. Mortality, wound complications, hospital charges, and doses of benzodiazepines, clonidine, and haloperidol were not significantly different between these 2 groups. Preoperative medical history correlated poorly with AWS outcomes. Screening was 87.5% sensitive and 99.7% specific. Late enrollees to the protocol (false-negative screening results) showed many significantly worse outcomes than immediate enrollees.

Conclusion  Use of the standardized AWS symptom-triggered protocol decreased delirium, violence, and AWS-related ICU transfers without significantly increasing hospital charges.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery (Drs Lansford, Turley, Groves, Bradford, Chepeha, Moyer, Prince, Wolf, and Teknos), The University of Michigan Hospital (Mss Guerriero, Kocan, and Aebersold), and Clinical Information Decision Support Services, University of Michigan Health System (Dr Bahl and Mr Abrahamse), Ann Arbor. Dr Lansford is now with the Department of Otolaryngology–Head and Neck Surgery, Carle Clinic Association, Urbana, Illinois; Dr Turley is now with the Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina; and Dr Groves is now with the Bobby R. Alford Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.

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