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Mortality after extrahepatic gastrointestinal and abdominal wall surgery in patients with alcoholic liver disease: A systematic review and meta-analysis

Adiamah, Alfred; Ban, Lu; Hammond, John; Jepsen, Peter; West, Joe; Humes, David .J.


Alfred Adiamah

Lu Ban

John Hammond

Peter Jepsen

Professor of Epidemiology

Clinical Associate Professor


Aims: This meta-analysis aimed to define the perioperative risk of mortality in patients with alcoholic liver disease (ALD) undergoing extrahepatic gastrointestinal surgery.

Methods: Systematic searches of Embase, Medline and CENTRAL were undertaken to identify studies reporting about patients with ALD undergoing extrahepatic gastrointestinal surgery published since database inception to January 2019. Studies were only considered if they reported on mortality as an outcome. Pooled analysis of mortality was stratified as benign and malignant surgery; and specific operative procedures where feasible.

Results: Of the 2899 studies identified only five studies met inclusion criteria. The operative procedures undertaken were cholecystectomy(n=1), umbilical hernia repair(n=1) and oesophagectomy(n=3). The total number of patients with ALD studied were 172. Therefore, any study on liver disease patients undergoing extrahepatic surgery that crucially included a subset with alcohol aetiology were included as a secondary analysis even though they failed to stratify mortality by underlying aetiology. The total number of studies that met this expanded inclusion criteria was 62, reporting on 37,703 patients with liver disease of which 1735 (4.5%) had a definite diagnosis of ALD. Meta-analysis of proportions of in-hospital mortality in patients with ALD undergoing upper gastrointestinal cancer surgery (oesophagectomy) was 23% (95% CI 14-35% I2=0%). In-hospital mortality following oesophagectomy in liver disease patients of all aetiologies was lower, 14% (95% CI 9-21% I2=41.1%).

Conclusion: Postoperative in-hospital mortality is high in patients with liver disease and ALD in particular. However, the currently available evidence on ALD is limited and precludes definitive conclusions on postoperative mortality risk.


Adiamah, A., Ban, L., Hammond, J., Jepsen, P., West, J., & Humes, D. .. (2020). Mortality after extrahepatic gastrointestinal and abdominal wall surgery in patients with alcoholic liver disease: A systematic review and meta-analysis. Alcohol and Alcoholism, 55(5), 497–511.

Journal Article Type Article
Acceptance Date Apr 28, 2020
Online Publication Date Jun 19, 2020
Publication Date 2020-09
Deposit Date May 4, 2020
Publicly Available Date Jun 20, 2021
Journal Alcohol and Alcoholism
Print ISSN 0735-0414
Electronic ISSN 1464-3502
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 55
Issue 5
Pages 497–511
Keywords ethanol, liver diseases, alcoholic liver diseases, cholecystectomy, gastrointestinal cancer, hospital mortality, surgical procedures, operative, mortality, surgery specialty, abdominal wall, gastrointestinal surgical procedures, causality
Public URL
Publisher URL
Additional Information This is a pre-copyedited, author-produced version of an article accepted for publication in Alcohol and Alcoholism following peer review. The version of record Alfred Adiamah, Lu Ban, John Hammond, Peter Jepsen, Joe West, David J Humes, Mortality After Extrahepatic Gastrointestinal and Abdominal Wall Surgery in Patients With Alcoholic Liver Disease: A Systematic Review and Meta-Analysis, Alcohol and Alcoholism, agaa043, is available online at:


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