Preoperative alcohol use disorders and adverse outcomes in surgical patients: A systematic review and meta-analysis

To evaluate the association between preoperative unhealthy alcohol use (UAU), including alcohol use disorder and hazardous/risky alcohol use, and postoperative outcomes in adult surgical patients. The Ovid MEDLINE, Embase, and Cochrane databases were searched for English-language studies involving adults undergoing surgery. Eligible studies compared patients with preoperative UAU to those with no UAU and reported at least one postoperative outcome within 12 months. Preoperative alcohol exposure was determined using validated assessment tools or self-reported alcohol use disorder. Random-effects meta-analyses were conducted to calculate risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Thirty-five studies ( n = 18,472,205) met inclusion criteria, and 35 studies were included in the meta-analyses. Preoperative alcohol use disorder was associated with a higher risk of respiratory complications (RR 2.59, 95% CI 1.51–4.45; P = 0.0005), infections/wound complications (RR 1.71, 95% CI 1.37–2.15; P < 0.0001), longer length of hospital stay (mean difference 0.76 days, 95% CI 0.24–1.29; P = 0.004), and higher in-hospital mortality (RR 1.67, 95% CI 1.21–2.29; P = 0.002). Surgical patients with alcohol use disorder were associated with worse postoperative outcomes, including higher rates of respiratory complications and infections, longer length of hospital stay and increased in-hospital mortality. These findings support screening for alcohol use and preoperative optimization including cessation support and postoperative monitoring. • Surgical patients with unhealthy alcohol use (UAU) had almost 3x more respiratory and 2x more greater infection/wound complications. • Surgical patients with UAU showed 70% higher in-hospital mortality and almost 1-day longer length of stay. • Males had over 2.5x higher odds of UAU, while females had ∼60% lower odds; UAU patients were consistently younger overall. • Routine preoperative alcohol screening may support integration of alcohol-focused risk assessment and perioperative care.