The relationship between alcohol consumption and outcomes after gastrointestinal surgery: a systematic review and meta-analysis

Abstract

The study aimed to summarise the evidence of the association between preoperative alcohol consumption and postoperative complications in gastrointestinal surgeries. Comprehensive searches of MEDLINE, EMBASE, and Cochrane databases were undertaken to identify original studies investigating the association between preoperative alcohol consumption and postoperative complications occurring within 30 days of surgery. The primary outcome was 30-day mortality risk and secondary outcomes included postoperative complications such as surgical site infections and risk of anastomotic leak. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random effects model. In total, 3601 reports were identified and reviewed for eligibility, then data was extracted from 26 studies that met inclusion criteria. 13 studies were included in the meta-analysis. The total number of patients in the meta-analysis was 686 181 including 20 163 with a high alcohol intake. Clearly defined high preoperative alcohol consumption was associated with an increased risk of postoperative complications including 30-day mortality (OR = 1.56; 95% CI: 1.07-2.28). The risk of anastomotic leak was significantly increased in those undergoing colorectal surgery with a high alcohol intake, OR 2.17 (95% CI: 1.74-2.72). An increase in risk was also found for surgical site infections in those undergoing gastrointestinal surgery with high alcohol intake. (OR = 1.32; 95% CI: 1.15-1.53). Preoperative alcohol consumption was associated with an increased risk of 30-day mortality, anastomotic leak and surgical site infections. Preoperative modulation of alcohol intake may influence post-operative complications after gastrointestinal surgery.

Keywords: alcohol consumption; gastrointestinal surgery; postoperative outcomes.

Figure 1

PRISMA flow diagram that maps out the identification of papers.

Figure 2

Forest plot for the association between preoperative alcohol consumption and 30-day mortality rate. There are two subgroups Upper Gastrointestinal and colorectal surgeries. Heterogeneity was assessed using the I² statistics with the associated P value (P). ^* denotes studies which report only event rate (Nickelsen et al). ^** Subtotal in Upper Gastrointestinal and colorectal subgroups; and ^** total - only include studies that provide actual events; apart from odds ratio which is a combined pooled estimate.

Figure 3

Forest plot for the association between preoperative alcohol consumption and risk of an anastomotic leak. ^* denotes studies which report only event rate (Nickelsen et al; and Surensen et al.). ^** Total - only include studies that provide actual events; apart from odds ration which is a combined pooled estimate.

Figure 4

Forest plot for the association between preoperative alcohol consumption and risk of SSI. ^* denotes studies which report only event rate (Nickelsen et al; and Surensen et al.). ^** Total - only include studies that provide actual events; apart from odds ratio which is a combined pooled estimate.

Figure 5

Risk of bias for cohort studies.

Figure 6

Risk of bias for case control studies.

Figure 7

Risk of bias for RCT.

Figure 8

Funnel plot for publication bias.