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People who have more than a couple of alcoholic drinks every day tend to have more complications after surgery than teetotalers or light drinkers, according to a review of past studies. This finding might be something UR or IMR physicians might want to consider when asked to authorize a surgery, or, this might be the basis of an argument for apportionment of permanent disability based upon causation in a case where a heavy drinker has a bad surgical outcome.

According to the summary in Reuters Health, the analysis confirms that “alcohol and surgery are a bad combination,” Bolette Pedersen of the Clinical Health Promotion Center of Bispebjerg and Frederiksberg University Hospital in Denmark, told Reuters Health by email. But it’s not clear what effect stopping drinking before surgery would have on complications, said Pedersen, who was not involved in the review.

Infections and slow wound healing were the most common complications associated with heavy drinking, according to lead author Marie Eliasen of the National Institute of Public Health at the University of Southern Denmark in Copenhagen.

Eliasen and her coauthors examined the results of 55 studies on pre-op drinking and post-op complications occurring up to 30 days after surgery. The studies looked at head and neck, abdominal and orthopedic surgeries for a variety of conditions, none of which was related to alcohol use. Patients who drank heavily leading up to surgery, including those who abused alcohol or were dependent on it, were more than twice as likely to die in the month after their procedures than abstainers – though the risk of dying varied greatly by procedure.

Heavy drinkers were also 73 percent more likely to contract a post-op infection, 80 percent more likely to have difficulty breathing and 29 percent more likely to be admitted to the intensive care unit than non-drinkers, according to results published in the Annals of Surgery. The associations were stronger with abdominal surgery – which can include gallbladder, liver and stomach procedures – than with other types of operations.

Low to moderate drinking – a drink or two per day or less – was not tied to post-op complications, but only a few studies addressed that group, Eliasen told Reuters Health. Heavy alcohol use over time compromises the immune system, which makes the body more susceptible to infections, she said. “Moreover, high alcohol consumption increases the endocrine stress response to surgery which may worsen existing conditions and reduces blood coagulation giving an increased risk of bleedings and slowing down wound healing processes,” she said.

The studies looked at alcohol consumption over different lengths of time, from months to years, so it’s unclear what duration of alcohol use leads to higher risks or when a patient’s drinking has the strongest effects. But it’s likely that the more you drink, the quicker the extra risks would appear, Eliasen said. A previous study found that post-op risks declined when patients stopped drinking four or more weeks before surgery, she said.