Abstract
BACKGROUND: Alcohol abuse leads to millions of hospital admissions each year in the United States. Alcohol withdrawal syndrome (AWS) is associated with several serious complications, including seizures, delirium tremens, and death. Benzodiazepines have been the mainstay of treatment for hospitalized patients with alcohol withdrawal. OBJECTIVE: To compare hospital length of stay (LOS) among different protocols for the management of AWS in hospitalized patients. METHODS: We conducted a retrospective study of 49,125 adult patients admitted over 4 years (2018-2022) to HCA Healthcare hospitals across the USA with a diagnosis of alcohol use disorder or alcohol withdrawal. Hospital LOS was the primary outcome examined across various treatment groups (chlordiazepoxide, diazepam, gabapentin, lorazepam, phenobarbital). Secondary outcomes included the initial Clinical Institute Withdrawal Assessment (CIWA) score, intensive care unit (ICU) admission rates, readmission rates, and mortality. RESULTS: The average age of patients admitted was 48 years, and the majority (72%) were White males. Lorazepam was the most frequently used protocol and was associated with the lowest LOS (3.96 days). Patients treated with lorazepam had relatively higher initial CIWA scores. Only 11% of patients were admitted to the ICU during their hospitalization, and only 2% were intubated or ventilated. There were no 30-day readmissions, and less than 1% of patients admitted with a diagnosis of AWS died. Other protocols, such as gabapentin, diazepam, phenobarbital, and chlordiazepoxide, were less commonly used and had variable impacts on the outcomes studied. CONCLUSIONS: The results of this retrospective study support lorazepam as an effective treatment for AWS management. Future research should focus on comparing the effectiveness of alcohol withdrawal assessment tools in patients with baseline psychiatric disorders.