Alcohol Drinking does not Affect Postoperative Surgical Site Infection or Anastomotic Leakage: A Systematic Review and Meta-analysis

Alcohol abuse appears to increase postoperative complications, but clinical trials have reported conflicting results. The objective of this systematic review and meta-analysis is to clarify how alcohol drinking affects postoperative surgical site infection and anastomotic leakage and to determine the impact of perioperative alcohol intervention. The databases MEDLINE, EMBASE, and CENTRAL were searched. Observational studies assessing surgical site infection and anastomotic leakage for alcohol drinkers and randomized controlled trials (RCTs) studying perioperative alcohol interventions were included. Meta-analyses were performed with random effects models. Methodological quality was assessed by the Newcastle-Ottawa Scale and Cochrane methodology. Fifteen observational studies and 2 RCTs were identified. Meta-analyses were performed for alcohol drinkers vs nondrinkers and moderate drinkers (a parts per thousand currency sign2 U/day), respectively. No difference between alcohol drinkers and nondrinkers was found. When drinkers and moderate drinkers were compared, a significantly higher incidence of surgical site infection and anastomotic leakage was found in unadjusted studies. In the meta-analysis of studies adjusting for smoking and age, alcohol drinking did not significantly affect surgical site infection and anastomotic leakage. The RCTs did not show any effect of perioperative alcohol abstinence or pharmacological withdrawal treatment on outcome. Alcohol drinking is not an independent risk factor for surgical site infection and anastomotic leakage. Interventions which aim to make patients quit alcohol or treat withdrawal symptoms do not seem to affect the surgical outcomes of interest.