To the Editor:
Terrando et al1 made an important point in stressing the early delirium and later ongoing aspects of postoperative cognitive decline. However, the possible role of alcohol could and should have been the major thrust of the discussion, not just a passing reference in Table 1. The following case illustrates this role.
A 74-year-old patient, about to undergo a “redo” of his prosthetic aortic valve, was asked if he took alcohol, to which he replied, “Just a couple of whiskeys with dinner.” The surgeon, being reassured, proceeded to operate. Postoperatively, the patient developed acute delirium tremens, fell out of bed, and fractured his hip. Subsequently, he fell a second time, refracturing the same hip. Dementia persisted, and he died after several months in a nursing home. It transpired that the patient, a distinguished medical scientist, was in great demand as a speaker, was constantly being entertained, and became a heavy drinker, habitually consuming a bottle of Scotch over lunch.
It would seem that several lessons can be drawn from this one case. (1) Patients are adept at concealing their true alcohol intake. (2) Widespread awareness of this danger might have averted the death of this patient. (3) Groups such as distinguished physicians and scientists, who travel extensively and are frequently wined and dined, might be suitable subjects for research regarding their alcohol consumption, along the lines of Doll and Hill's study that led to the timeless discovery of the relationship between smoking and lung cancer in physicians.2
References
- 1.Terrando N., Brzezinski M., Degos V. Perioperative cognitive decline in the aging population. Mayo Clin Proc. 2011;86(9):885–893. doi: 10.4065/mcp.2011.0332. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Doll R., Hill A.B. The mortality of doctors in relation to their smoking habits: a preliminary report. Br Med J. 1954;1(4877):1451–1455. doi: 10.1136/bmj.1.4877.1451. [DOI] [PMC free article] [PubMed] [Google Scholar]