Both alcohol drinking and depression are risk factors for postoperative
confusion and are associated with alteration of pituitary-adrenal function. We investigated the incidence of postoperative
confusion, plasma
cortisol and
ACTH response to surgical stress in depressed patients with
alcohol abuse. We studied sixty depressed patients with and without
alcohol abuse who underwent abdominal surgery. Postoperative
confusion occurred in 4 of 30 patients (13%) in depressed patients without
alcohol abuse, 10 of 30 patients (33%) in depressed patients with
alcohol abuse. Plasma
cortisol concentrations (27.2 +/- 7.0, 28.3 +/- 8.2, 29.2 +/- 4.1, 28.0 +/- 6.3 and 27.9 +/- 5.7 microg dl(-1)) 15, 60 min after the skin incision, 60 min after the end of surgery, the next day and the third day after surgery in depressed patients with
alcohol abuse were significantly higher than that (20.1 +/- 6.4, 21.7 +/- 9.6, 22.3 +/- 8.0, 21.9 +/- 6.7 and 20.3 +/- 5.4 microg dl(-1)) in depressed patients without
alcohol abuse. In depressed patients with
alcohol abuse, plasma
cortisol concentrations (34.9 +/- 7.1, 33.2 +/- 5.8 and 33.4 +/- 5.5 microg dl(-1)) 60 min after the end of surgery, the next day and third day after surgery in postoperatively confused depressed patients were significantly higher than those (26.4 +/- 6.3, 25.4 +/- 5.0 and 25.2 +/- 4.9 microg dl(-1)) of nonconfused depressed patients. In conclusion, the incidence of postoperative
confusion was significantly higher in depressed patients with
alcohol abuse than in depressed patients without
alcohol abuse. Increased plasma
cortisol concentrations after surgery were associated with postoperative
confusion in depressed patients with
alcohol abuse.