Bariatric surgery significantly raises the risk of alcohol use disorder (AUD) and alcohol-related mortality, crucial for surgical decision-making.

• Gastric bypass (GBP) patients face a 5.07 times higher AUD risk, while vertical banded gastroplasty (VBG) and gastric banding patients are 2.28 and 2.34 times more likely to develop AUD, respectively.
• Alcohol-related mortality is 6.18 times higher after GBP and 3.56 times higher after VBG compared to usual obesity care; gastric banding’s impact is less certain.

Surgeons must prioritize preoperative assessments and ongoing monitoring for AUD in at-risk patients.