Alcohol withdrawal prophylaxis in patients undergoing surgical treatment of head and neck squamous cell carcinoma

Objectives: Alcohol abuse is common in patients with squamous cell cancer of the head and neck. Postoperative alcohol withdrawal is associated with increased morbidity and prolonged hospitalization and is commonly treated with benzodiazepines. We reviewed our experience with benzodiazepine prophylaxis in high-risk patients undergoing surgical treatment of head and neck cancer. We sought to determine whether benzodiazepine prophylaxis was successful in preventing complications from alcohol withdrawal. Study Design: Nonrandomized, retrospective patient analysis. Methods: The medical records of all patients diagnosed with squamons cell carcinoma of the head and neck from 1999 to 2004 were retrospectively reviewed. Patients who underwent surgical resection and who were considered high risk for postoperative alcohol withdrawal received benzodiazepine prophylaxis following an established institutional protocol and comprised the study group. Results: Of 96 patients who met study criteria, 13 (13.5%) patients developed alcohol withdrawal symptoms, and 9 (9.4%) patients developed delirium tremens. Patients who manifested alcohol withdrawal remained in the hospital an average of 10.8 days longer (19.0 vs. 8.2) and had an overall complication rate of 50% (11 of 22) versus a 17.6% (13 of 74) complication rate in patients that did not develop withdrawal (P < .05). Conclusions: Alcohol withdrawal is associated with a significantly greater incidence of postoperative complications and duration of hospitalization. Benzodiazepine prophylaxis does not prevent postoperative alcohol withdrawal symptoms in all patients at risk. Alternate methods of prophylaxis should be explored.