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Alcohol consumption is a well-documented determinant of adverse perioperative outcome. Previous studies, however, lack adequate sample size and cannot account for multiple internal biases. Using a national administrative database, we sought to determine the independent effect of alcohol consumption upon morbidity and mortality following elective surgery.Methods: We queried discharge records from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP, 2005 to 2007) for all elective adult admissions. 7631 (2.5%) patients with documented alcohol exposure (active alcohol use of at least 2 drinks per day within two weeks of surgery) underwent elective surgery; 301994 patients did not have active alcohol exposure. Multivariate analysis was performed with adjustments for demographic and comorbid factors. Primary outcome measures included length of stay, wound infection, sepsis, and death.Results: Elective laparoscopic cholecystectomy, inguinal hernia, and laparoscopic gastric bypass were performed most frequently in this cohort. The trend of alcohol consumption associated with all elective surgery decreased over the course of the study (p<0.0001). Alcohol use was an independent predictor of pneumonia (OR 1.98, 95% CI 1.84-2.13), sepsis (OR 1.19, 95% CI 1.03-1.37), superficial surgical site infection (SSI; OR 1.15, 95% CI 1.02-1.31), wound disruption (OR 1.41, 95% CI 1.11-1.80) and prolonged hospital stay (OR 1.17, 95% CI 1.08-1.26). Except for SSI, these complications were independent risk factors for postoperative mortality. Alcohol consumption was associated with earlier time to wound disruption (9 vs. 11 days; p=0.04), longer median hospital stays (5 vs. 3 days; p<0.0001), and days from operation to discharge (4 vs.3 days; p<0.0001). A sensitivity analysis revealed that when infectious complications were removed, a significant effect of alcohol exposure on mortality was observed.Conclusions: Alcohol consumption is a significant determinant of adverse outcomes in elective surgery; patients who regularly consume alcohol who are scheduled to receive elective surgery should be appropriately educated. Elective surgery performed under optimal conditions of limited alcohol consumption or abstinence may reduce post operative complications, length of stay, and hospital costs.