PTH-071 Audit Of Subsequent Outcome In Patients Admitted To Hospital With Alcohol Use Disorder (aud).

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PTH-071 Audit Of Subsequent Outcome In Patients Admitted To Hospital With Alcohol Use Disorder (aud).

Gut. 2014 Jun;63 Suppl 1:A240-1

Authors: Rai S, Boyce H, Anderson F, Gleeson D

INTRODUCTION: There are limited published data on subsequent outcome of patients admitted acutely to hospital with alcohol use disorders (AUDs), in regard to drinking relapse, hospital readmission and death.
METHODS: We conducted a prospective audit of 142 patients (105 men), aged (median (range) 46 (23-78) years) admitted with AUDs to a medical admission unit during Oct-Nov 2012 and Jan-March 2013. Information on hospital readmission, AandE attendance and death (from hospital electronic records), and on subsequent alcohol drinking (from records and from telephoning patients) was gathered up to 21/05/13. Data were analysed by life-table and Cox regression analysis.
RESULTS: Of the 142 patients, 80 (56%) lived alone and 121 (85%) were unemployed. 36 patients (25%) had liver disease (Child-Pugh Grade B/C). Of 92 patients with CT or MRI brain scan within 5 years, 49 (53%) had brain atrophy. 73 patients (51%) had another mental health problem (anxiety or depression in 68, schizophrenia in 5). Over the previous year, 71 (50%) had >1 previous AUD-related admission, and 24 (17%) had >3 such admissions. Out of 110 patients, 79% of patients said they intended to stop drinking. Length of stay during index admission was 6 (0-61 days). 51 patients experienced complications, 29 self-discharged early and 18 were verbally ± physically abusive. 5 patients died during admission, 4 from liver disease. 17 discharged patients were lost to follow up; of the remaining 120, 96 relapsed into drinking, 18 (0-168 days) after discharge. 100-day relapse rate was 78%. When asked the reason for relapse (n = 87), 53 patients cited "no particular reason", 22 depression, 5 a traumatic experience and 4 a celebratory event. Relapse was independently associated with self-discharge after index admission (p < 0.001). 77 patients (56%) were readmitted to hospital, 66 (86%) for clearly alcohol-related reasons. 13 more patients re-attended the AandE Department without readmission. 100 day readmission rate was 50%. 19 patients were readmitted twice and 23 patients >3 times. Readmission was independently associated with unemployment (p = 0.043), self-discharge after index admission (p = 0.011), relapse into drinking (p = 0.028), and (surprisingly) with having received a brief intervention regarding alcohol consumption during the index admission from a dedicated alcohol worker (n = 61, p = 0.009). Seven more patients had died by 21/05/13, 5 from liver disease.
CONCLUSION: Patients admitted to hospital with AUDs tend to be socially deprived, frequent hospital attenders with major physical and mental co-morbidity. They have high subsequent alcohol relapse and hospital readmission rates. Reduction of these is not achieved by interventions during the index admission and will require more pro-active measures post-discharge.

PMID: 25021762 [PubMed - in process]