Effects of alcohol consumption on postoperative outcomes: a scoping review

Alcohol consumption is associated with dose-dependent health loss secondary to long-term intake. In this scoping review, we sought to synthesize the literature on the association between the dose of preoperative alcohol consumption and postoperative outcomes.

We included studies with adults undergoing cardiac and major noncardiac surgery reporting the dose of preoperative alcohol and postoperative outcomes. We searched MEDLINE, Embase®, and Cochrane Databases for Controlled Trials and Systematic Reviews. Outcomes were mortality, intensive care unit (ICU) admission, length of stay (LOS), delirium, surgical site infection (SSI), major cardiac and renal events, and postoperative pulmonary complications (PPCs). We assessed risk of bias (ROB) using the Newcastle-Ottawa Scale (cohort) and Joanna Briggs Institute tool (cross-sectional). We registered the protocol at PROSPERO (CRD42023474001).

Of 9,591 references, we included 23 studies, and 7 exhibited high ROB. When consumed regularly, alcohol was associated with an increase in postoperative mortality (three of six studies), ICU admission (two of three studies), LOS (four of six studies), delirium (one of four studies), SSI (five of nine studies), and PPCs (one of three studies). No meaningful change in the results emerged when the high-ROB studies were removed. No consistent threshold of alcohol consumption was evident, though some studies implied an association with a dose of ≥ 2 drinks equivalents·day^-1. Renal (one study) and cardiac complications (three studies) were not linked with preoperative alcohol consumption.

The association between alcohol dose and postoperative complications is inconsistent across observational studies.