(A538) Effects of Alcohol Withdrawal on Free Flap Outcomes

Monday, October 13, 2025

12:00 PM - 1:00 PM EDT

Location: OTO EXPO, Posters

Presenting Author(s)

AK

Amy Katherine Krecker, MD

Resident
University of Mississippi Medical Center
Jackson, Mississippi, United States

Co-Author(s)

Alexandra E. Kejner, MD

Associate Professor
Medical University of South Carolina Rutledge Tower Annex
CHARLESTON, South Carolina, United States

Senior Author(s)

Anne Kane, MD

Associate Professor
University of Alabama at Birmingham
Birmingham, Alabama, United States

Co-Author(s)

CW

Chase Walton, Other

Medical University of South Carolina, United States
Sarah J. Hayek, BS

Medical Student
University of Mississippi Medical Center
Jackson, Mississippi, United States
Angelica M. Walker, BS

Medical Student
Medical University of South Carolina
Charleston, SC, United States
KS

Kendra Stephen, Other

UT Southwestern, United States
NS

Nina Stephen, Other

UT Southwestern, United States
James D. Warren, MD

Resident Physician
Louisiana State University Health Sciences Center - New Orleans
Baton Rouge, Louisiana, United States
Isabella Schafer, Other

Medical Student
Medical University of South Carolina
Charleston, South Carolina, United States

Disclosure(s):

Amy Katherine Krecker, MD: No relevant relationships to disclose.

Alexandra E. Kejner, MD: No relevant relationships to disclose.

Anne Kane, MD: No relevant relationships to disclose.

Sarah J. Hayek, BS: No relevant relationships to disclose.

Angelica M. Walker, BS: No relevant relationships to disclose.

James D. Warren, MD: No relevant relationships to disclose.

Isabella Schafer, Other: No relevant relationships to disclose.

Introduction: Heavy alcohol consumption is a risk factor for developing head and neck cancer (HNC) and is associated with significant perioperative risks, including risk of alcohol withdrawal syndrome (AWS). Oncologic resection and free flap (FF) reconstruction is a primary treatment modality for advanced HNC. Post-operative admission can place patients at risk of developing AWS. With the high incidence of heavy alcohol use in HNC patients, we aim to investigate the incidence and the effects of AWS on FF outcomes and overall hospital course.

Methods: IRB-approved retrospective chart review was completed at three tertiary academic centers including adult patients who had undergone FF for HNC from 2017 to 2023. Pre-operative social history and post-operative alcohol withdrawal were investigated alongside patient demographics and other peri-operative data.

Results: The cohort included 478 patients, mean age 61.1 years (range 21–94), with 72.2% men. Patients were mostly White (69.9%) and Black (25.9%) and the majority of patients had squamous cell carcinoma (81.7%). Within the cohort, 15 patients (3.14%) experienced AWS during admission. AWS resulted in significantly higher rates of flap failure (p = 0.045), increased length of stay (p < 0.001), increased ICU length of stay (p = 0.017), and increased rates of rapid response codes (p = 0.026). The most common regimens for treatment of AWS were benzodiazepine-based (CIWA, MINDS), gabapentin taper, and prophylactic alcohol. There was no significant difference in mortality, readmission, discharge diet, discharge destination, or code event. Comparison of different prophylactic and treatment regimens revealed no difference in development or duration of AWS.

Conclusions: AWS remains a significant problem for HNC patients with post-operative course being significantly affected in patients undergoing FF procedures. To our knowledge, this is the largest cohort of HNC FF patients evaluated on this subject. Future prospective studies are needed to determine optimal preventive regimen to improve patient outcomes.