Surgical procedures in patients with alcohol-related cirrhosis: a Danish nationwide register-based cohort study

Alcohol-related cirrhosis (ALD cirrhosis) is a chronic liver disease caused by excessive alcohol consumption. Patients with ALD cirrhosis have increased risk of conditions that may require surgery for example gallstones, gastrointestinal cancers, and hernias, but surgeons may prefer to avoid surgery due to patients’ increased risk of complications. We compared the incidence of surgery between patients with ALD cirrhosis and matched comparators. We used nationwide healthcare registries to include all Danish citizens diagnosed with ALD cirrhosis in 1996–2018. Follow-up began at the time of cirrhosis diagnosis and ended at death or 10 years after diagnosis. We compared their incidence rates and cumulative risks of surgery (excluding biopsies, punctures, drainages, injections, and diagnostic endoscopies) with those for a gender- and age-matched comparator cohort from the general Danish population. We included 23,050 patients with ALD cirrhosis and 113,412 matched comparators. The incidence rate ratio (IRR) for surgery overall was 3.38 [95% Confidence Interval (CI): 3.34–3.41] for patients vs. comparators. The 1-year risk of surgery was 42.6% [95% CI: 42.4–42.9] for patients vs. 13.4% [95% CI: 13.3–13.6] for comparators. Abdominal procedures were the most frequent surgical category for the patients with an IRR of 6.55 [95% CI: 6.41–6.69] for patients vs. comparators. We found an increased risk of surgery for patients with ALD cirrhosis compared with the general Danish population. Given the frequency of surgery in these high-risk patients, further research should focus on perioperative management to optimize outcomes.