Reducing the High Post-Surgical Pneumonia Rate in Alcoholics

A new treatment dramatically decreases the usually high post-surgical pneumonia rate for alcoholic patients who have undergone aerodigestive tract surgery for cancer.

By infusing these patients with low-dose ethanol, morphine or ketoconazole (an antifungal agent) just before surgery and until the third postoperative day, researchers reduced the incidence of pneumonia from 39 percent to 5.7 percent.The research appears in the second issue for August 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.Claudia Spies, M.D., of the Departments of Anaesthesiology and Intensive Care Medicine at Charite-University Medicine Berlin in Germany, and 20 associates used these interventions on 53 patients to alter their immune response to surgical stress and to reduce the amount of time they spent in the intensive care unit (ICU).”The intervention shortened the patient’s ICU stay by 9 days, compared to placebo-treated alcoholics,” said Dr. Spies.According to the authors, every fifth patient admitted to a general hospital has an alcohol problem. In patients undergoing surgery of the aerodisgestive tract, the rate of alcohol abuse exceeds 50 percent. Since long-term alcohol use raises the risk of infection after surgery, post-surgery pneumonia rates are three to four times higher in alcoholics.(The aerodigestive tract involves the combined organs and tissues of the respiratory tract and upper part of the digestive tract. Upper areas include the lips, mouth, tongue, nose, throat, vocal cords and part of the esophagus and windpipe.)The experimental interventions helped to inhibit cortisol response in the patients. Hypercortisolism is a condition that results from an excess of cortisol, a hormone produced by the adrenal glands. The problem is reported in long-term alcoholics after surgical stress. An elevated cortisol level results in immune suppression and is associated with increased infection rates.Long-term alcoholic patients show a three- to four-fold increased risk of infection after surgery, added Dr. Spies. Because of the increased post-operative morbidity, intensive care unit treatment and overall hospital stay are prolonged. Among all infections, pneumonia is the most relevant and is associated with the worst outcome for the patient, with increased hospital costs. The pneumonia rate reported by previous studies is about 35 percent, which is strikingly high compared to 12.8 percent in ventilated medical and surgical patients.The patients given the experimental treatments were mostly male and had a median age of 55. They stayed two days in the ICU, as compared to 11 days for the 18 alcoholic patients who were on placebo.Seven (39 percent) of the 18 alcoholic patients on placebo developed pneumonia after surgery, while only three of those treated suffered from the disease.(Source: American Journal of Respiratory and Critical Care Medicine: American Thoracic Society: August 2006).