Background: Excessive alcohol consumption has a negative effect on the immune system. However, its impact on the surgical outcomes following esophageal/esophageal-gastric resection for cancer is unknown. The purpose of this study was to assess the association between the chronic alcohol abuse and the surgical outcomes following esophageal cancer surgery by using a population-based discharge database.

Methods: A retrospective cohort study was conducted to include adult patients (≥18 years) who were diagnosed with malignancy of esophagus and underwent esophagectomy or gastrectomy during 2002-2006 by using data from the US Nationwide Inpatient Sample. Postoperative infections and length of hospital stay were the outcomes of interest. Multiple logistic regression models were used to assess the association between the chronic alcohol abuses with postoperative infection while controlling for confounding factors. Kaplan-Meier curves were constructed and compared by using the log-rank test.

Results: A total of 2,247 patients had esophageal cancer resections. The overall postoperative infection rate was 6.1%. The patients with co morbid alcohol abuse (5.1%) were younger (mean[standard deviation]: 60.6[9.7] vs. 63.4[11.0] years, P=0.006), less likely to be female (10.7% vs. 18.7%, P=0.03), and had a similar mortality rate (11.6% vs. 7.5%, P=0.11) as compared to the patients without the history of alcohol abuse. However, the postoperative infection rate was significantly higher (12.5% vs. 5.8%, P=0.004). From a multivariate logistic regression model, history of alcohol abuse was significantly associated with increased postoperative infection (odds ratio: 1.95, 95% confidence interval: [1.03, 3.66], P=0.04), when controlling for age, gender and diabetes. In addition, alcoholic patients had a significantly longer length of hospital stay (median: 16 vs. 12 days, P=0.02).

Conclusion: This study demonstrated that patients with co morbid alcohol abuse had a higher chance of postoperative infection and a much longer length of hospital stay following surgery for esophageal cancer.