PTH-071 Audit of Subsequent outcome in Patients Admitted to Hospital with Alcohol use Disorder (AUD)

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Abstract

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.

Results

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).

Results

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.

Disclosure of Interest

None Declared.

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