***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: OBJECTIVE To show clinical benefit in the main outcome measures by the use of a st and ardized protocol for identification , characterization , and treatment of alcohol withdrawal syndrome ( AWS ) in postoperative patients with head and neck cancer . DESIGN Prospect i ve cohort study with a retrospective cohort control . SETTING Tertiary care university . PATIENTS A total of 26 consecutive postoperative patients with AWS were selected from among 652 patients with head and neck cancer to be enrolled in the protocol from March 2003 through March 2005 . Controls consisted of 14 of 981 consecutive patients with AWS from March 2000 through December 2002 . INTERVENTION Application of a st and ardized care protocol . MAIN OUTCOME MEASURES Sensitivity and specificity of preoperative screening for AWS risk , predictability of outcomes , length of stay , transfers to the intensive care unit ( ICU ) , AWS symptoms , postoperative morbidity and mortality , doses of pharmacotherapy required , and charges . RESULTS Protocol patients demonstrated significantly fewer AWS-related ICU transfers and less delirium and violence than pre protocol patients . Mortality , wound complications , hospital charges , and doses of benzodiazepines , clonidine , and haloperidol were not significantly different between these 2 groups . Preoperative medical history correlated poorly with AWS outcomes . Screening was 87.5 % sensitive and 99.7 % specific . Late enrollees to the protocol ( false-negative screening results ) showed many significantly worse outcomes than immediate enrollees . CONCLUSION Use of the st and ardized AWS symptom-triggered protocol decreased delirium , violence , and AWS-related ICU transfers without significantly increasing hospital charges Abstract Objective : To evaluate the influence of preoperative abstinence on postoperative outcome in alcohol misusers with no symptoms who were drinking the equivalent of at least 60 g ethanol/day . Design : R and omised controlled trial . Setting : Copenhagen , Denmark . Subjects : 42 alcoholic patients without liver disease admitted for elective colorectal surgery . Interventions : Withdrawal from alcohol consumption for 1month before operation ( disulfiram controlled ) compared with continuous drinking . Main outcome measures : Postoperative complications requiring treatment within the first month after surgery . Perioperative immunosuppression measured by delayed type hypersensitivity ; myocardial ischaemia and arrhythmias measured by Holter tape recording ; episodes of hypoxaemia measured by pulse oximetry . Response to stress during the operation were assessed by heart rate , blood pressure , serum concentration of cortisol , and plasma concentrations of glucose , interleukin 6 , and catecholamines . Results : The intervention group developed significantly fewer postoperative complications than the continuous drinkers ( 31 % v 74 % , P=0.02 ) . Delayed type hypersensitivity responses were better in the intervention group before ( 37 mm2 v 12 mm2 , P=0.04 ) , but not after surgery ( 3 mm2 v 3 mm2 ) . Development of postoperative myocardial ischaemia ( 23 % v 85 % ) and arrhythmias ( 33 % v 86 % ) on the second postoperative day as well as nightly hypoxaemic episodes ( 4 v 18 on the second postoperative night ) occurred significantly less often in the intervention group . Surgical stress responses were lower in the intervention group ( P≤0.05 ) . Conclusions : One month of preoperative abstinence reduces postoperative morbidity in alcohol abusers . The mechanism is probably reduced pre clinical organ dysfunction and reduction of the exaggerated response to surgical stress In a prospect i ve study of 7735 middle-aged 7 British men , 504 of whom died in a follow-up period of 7.5 years , there was a U-shaped relationship between alcohol intake and total mortality and an inverse relationship with cardiovascular mortality , even after adjustment for age , cigarette smoking , and social class . These mortality patterns were seen in all smoking categories ( with ex-smoking non-drinkers having the highest mortality ) and were observed in manual but not in non-manual workers . The alcohol-mortality relationships ( total and cardiovascular ) were present only in men with cardiovascular or cardiovascular-related doctor-diagnosed illnesses at initial examination . The data suggest that the observed alcohol-mortality relationships are produced by pre-existing disease and by the movement of men with such disease into non-drinking or occasional-drinking categories . The concept of a " protective " effect of drinking on mortality , ignoring the dynamic relationship between ill-health and drinking behaviour , is likely to be ill founded AIM To assess the effectiveness of a tailored pre-operative intervention for excessive alcohol consumption in reducing post-operative complications and alcohol consumption thereafter . METHODS Patients scheduled for elective surgery requiring at least overnight hospitalisation were screened for alcohol misuse . Consenting , eligible participants with > or = 7 days to surgery at the time of screening were offered an intervention and those with < 7 days to surgery were provided usual care . RESULTS Over a period of 2 years and 10 months , 3139 patients were screened to recruit 136 participants . Baseline analysis revealed a mean age of 53 ( + /-15.8 ) years and a mean consumption of 71 g/day ( + /-48.1 ) . The intervention group ( n = 45 ) did not differ significantly from controls ( n = 91 ) in age , consumption , and number of current smokers , but there were significantly more women in the control group . There was no difference between the groups in major or minor complications experienced , or length of stay after controlling for age , gender , and baseline consumption . At 6-month follow-up there was a significant reduction in drinking for the entire study population . CONCLUSION The study did not demonstrate any beneficial effect of the pre-operative intervention on post-operative complications . The relatively short time to surgery , intervention by a non-member of the surgical team , challenges to recruitment and reduced consumption in the control group may have limited the ability of the study to detect a significant effect of the intervention Postoperative morbidity after hysterectomy was prospect ively studied in 229 consecutive patients in our departments . The incidence of alcohol abuse ( greater than 60 gm of alcohol daily ) and social drinking ( between 25 and 60 gm of alcohol daily ) was 6.5 % for each . When compared with the social drinkers and the control group , the alcohol abuse group had significantly more complications ( 80 % vs 27 % and 80 % vs 13 % , respectively ) PURPOSE  Morbidity after radical cystectomy  is common and associated with increased health care re source use . Accurate characterization of complications after cystectomy , associated patient specific risk factors , and perioperative processes of care are essential to directing changes in perioperative management that will reduce morbidity and improve the quality of patient care . MATERIAL S AND METHODS The National Surgical Quality Improvement Program ( NSQIP ) is a prospect i ve quality management initiative of 123 Veterans Affairs Medical Centers nationwide . The NSQIP collects clinical information , intraoperative data and outcomes on a wide variety of surgical procedures from multiple surgical disciplines . Since 1991 , 2,538 radical cystectomy procedures have been captured by the NSQIP . Modeling using logistic regression was performed to identify patient specific risk factors and perioperative process measures associated with postoperative morbidity . RESULTS Of the 2,538 subjects at least 1 postoperative complication developed in 774 ( 30.5 % ) . The most frequent complication was ileus ( 10 % ) . Several factors were associated with the development of a complication , including age , dependent functional status , preoperative dyspnea , preoperative acute renal failure , chronic steroid use , preoperative alcohol consumption , American Society of Anesthesiology score , use of general anesthetic , operative time , intraoperative blood requirement and surgeon level of training . CONCLUSIONS Morbidity remains high after cystectomy with 30.5 % of subjects experiencing at least 1 complication . Measurable patient specific risk factors and perioperative processes associated with postoperative morbidity following cystectomy are now delineated which allows for improved risk stratification , patient counseling , and the development of novel processes that may incrementally reduce risk and improve outcomes There are many papers comparing two antibiotic protocol s for the profilaxis of head and neck infections after laryngeal surgery . We present one prospect i ve and r and omised study in 60 patients comparing the efficacy of two protocol s. The comparison was between ceftriaxone versus the association of clindamicyn and gentamicyn . In our data base we included the risk factors for infection , the surgical approach , the duration of surgery and the patient characteristics . We observed an incidence of 28 % of infection , with a 23.3 % in the clindamicyn + gentamicyn group and a 33.3 % in the ceftriaxone group . The differences between the two groups were not statistically significant . In this study we observed a small difference between the amount of alcohol comsuption , the effectiveness of the surgical drainage , the surgical approach and the presence of wound infection . The difference was not statistical significant due to the small group of patients . The profilaxis was adequate for the total laryngectomy and cordectomy group , with a higher incidence of wound infection in patients treated with a supraglottic laryngectomy Study Design . This is a multivariate analysis of a prospect ively collected data base . Objective . To determine preoperative , intraoperative , and patient characteristics that contribute to an increased risk of postoperative wound infection in patients undergoing spinal surgery .  Summary of Background Data . Current literature sites a postoperative infection rate of approximately 4 % ; however , few have completed multivariate analysis to determine factors which contribute to risk of infection . Methods . Our study identified patients who underwent a spinal decompression and fusion between 1997 and 2006 from the Veterans Affairs ’ National Surgical Quality Improvement Program data base .  Multivariate logistic regression analysis was used to determine the effect of various preoperative variables on postoperative infection . Results . Data on 24,774 patients were analyzed .  Wound infection was present in 752 ( 3.04 % ) patients , 287 ( 1.16 % ) deep , and 468 ( 1.89 % ) superficial . Postoperative infection was associated with longer hospital stay ( 7.12 vs. 4.20 days ) , higher 30-day mortality ( 1.06 % vs. 0.5 % ) , higher complication rates ( 1.24 % vs. 0.05 % ) , and higher return to the operating room rates ( 37 % vs. 2.45 % ) . Multivariate logistic regression identified insulin dependent diabetes ( odds ratios [ OR ] = 1.50 ) , current smoking ( OR = 1.19 ) ASA class of 3 ( OR = 1.45 ) or 4 to 5 ( OR = 1.66 ) , weight loss ( OR = 2.14 ) , dependent functional status ( 1.36 ) preoperative HCT < 36 ( 1.37 ) , disseminated cancer ( 1.83 ) , fusion ( OR = 1.24 ) and an operative duration of 3 to 6 hours ( OR = 1.33 ) or > 6 hours ( OR = 1.40 ) as statistically significant predictors of postoperative infection . Conclusion . Using multivariate analysis of a large prospect ively collected data from the National Surgical Quality Improvement Program data base , we identified the most important risk factors for increased postoperative spinal wound infection . We have demonstrated the high mortality , morbidity , and hospitalization costs associated with postoperative spinal wound infections . The information provided should help alert clinicians to presence of these risks factors and the likelihood of higher postoperative infections and morbidity in spinal surgery patients RATIONALE Postoperative pneumonia is three to four times more frequent in patients with alcohol use disorders followed by prolonged intensive care unit ( ICU ) stay . Long-term alcohol use leads to an altered perioperative hypothalamus-pituitary-adrenal ( HPA ) axis and immunity . OBJECTIVES The aim of this study was to evaluate HPA intervention with low-dose ethanol , morphine , or ketoconazole on the neuroendocrine-immune axis and development of postoperative pneumonia in long-term alcoholic patients . METHODS In this r and omized , double-blind controlled study , 122 consecutive patients undergoing elective surgery for aerodigestive tract cancer were included . Long-term alcohol use was defined as consuming at least 60 g of ethanol daily and fulfilling the Diagnostic and Statistical Manual of Mental Disorders IV criteria for either alcohol abuse or dependence . Nonalcoholic patients were included but only as a descriptive control . Perioperative intervention with low-dose ethanol ( 0.5 g/kg body weight per day ) , morphine ( 15 mug/kg body weight per hour ) , ketoconazole ( 200 mg four times daily ) , and placebo was started on the morning before surgery and continued for 3 d after surgery . Blood sample s to analyze the neuroendocrine-immune axis were obtained on the morning before intervention and on Days 1 , 3 , and 7 after surgery . MEASUREMENTS AND MAIN RESULTS In long-term alcoholic patients , all interventions decreased postoperative hypercortisolism and prevented impairment of the cytotoxic T-lymphocyte type 1:type 2 ratio . All interventions decreased the pneumonia rate from 39 % to a median of 5.7 % and shortened int 
    Output:
    
When drinkers and moderate drinkers were compared , a significantly higher incidence of surgical site infection and anastomotic leakage was found in unadjusted studies .
In the meta- analysis of studies adjusting for smoking and age , alcohol drinking did not significantly affect surgical site infection and anastomotic leakage .
The RCTs did not show any effect of perioperative alcohol abstinence or pharmacological withdrawal treatment on outcome .
Conclusions Alcohol drinking is not an independent risk factor for surgical site infection and anastomotic leakage  .
Interventions which aim to make patients quit alcohol or treat withdrawal symptoms do not seem to affect the surgical outcomes of interest