Alcohol Use Disorder: ‘Significant’ Association With VTE

How big of a contributor is alcohol use disorder to postoperative complications after total knee arthroplasty (TKA)? A group of researchers designed a retrospective review to answer that question and their work, which examined length of stay and cost of care, was published in the June 15, 2021 edition of The Journal of the American Academy of Orthopaedic Surgeons: “A Matched Control Analysis on the Effects of Alcohol Use Disorder After Primary Total Knee Arthroplasty in Medicare Patients.”

Co-author T. David Luo, M.D. is with the Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. The underlying issue, Dr. Luo told OTW, is that “Alcohol use disorder [AUD] is a very prevalent mental health disorder in the U.S. and abroad and the medical effects of alcohol use disorder can lead to coagulation derangements and liver disease, which may severely impact outcomes after total knee arthroplasty.”

This study is a retrospective Level III case–control review of Medicare patients with alcohol use disorder who had been treated with primary TKA between 2005 and 2014. The team used the PearlDiver database to collect data on 354,690 TKA patients: 59,126 with alcohol use disorder and 295,564 without alcohol use disorder.

According to Dr. Luo, “Patients with alcohol use disorder had greater risk of venous thromboembolism [VTE] and implant-related complications compared to matched controls. In a subset of alcohol use disorder patients with concomitant cirrhosis, the rate of VTE and implant-related complications other than PJI [periprosthetic joint infection] was not significantly greater compared to non-cirrhotic patients.”

Specifically, the authors wrote, “Patients with alcohol use disorder had significantly greater odds ratio of medical complications, including venous thromboembolism within 90 days (OR: 1.41, P <0.0001) and at 1 year (OR: 1.51, P < 0.0001) and greater 2-year implant-related complications after primary TKA. Furthermore, patients with alcohol use disorder had significantly longer lengths of stay (4 versus 3 days, P <0.0001) and incurred a significantly higher episode of care costs ($15,569.76 versus $13,763.06, P <0.0001).”

What to do?

“Alcohol use disorder is a difficult diagnosis to manage,” stated Dr. Luo to OTW, “but recognizing it during the preoperative workup will help the surgeon counsel the patient regarding potential postoperative complications. Recognizing any laboratory abnormalities may prompt further optimization from a hepatology specialist to ensure better outcomes.”

“Similar to other underlying medical co-morbidities, alcohol use disorder should be recognized by the patient and surgeon as a major risk factor that could lead to serious postoperative complications and prolonged hospital stays. This may prompt surgeons to utilize all necessary resources, including preoperative optimization pathways and postoperative medical co-management teams to ensure the best possible outcomes.”