Association of preoperative smoking with complications following major gastrointestinal surgery

• Published in: The American journal of surgery Vol. 223; no. 2; pp. 312 - 317
• Main Authors: Brajcich, Brian C., Yuce, Tarik K., Merkow, Ryan P., Bilimoria, Karl Y., McGee, Michael F., Zhan, Tiannan, Odell, David D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022; Elsevier Limited
• Subjects: Body mass index; Chronic obstructive pulmonary disease; Complications; Datasets; Digestive system surgical procedures; Digestive System Surgical Procedures - adverse effects; Dyspnea; Elective surgical procedures; Elective Surgical Procedures - adverse effects; Ethnicity; Gastrointestinal surgery; Hispanic people; Humans; Length of stay; Morbidity; Mortality; Optimization; Overweight; Patient Readmission; Patients; Pneumonia; Postoperative complications; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Risk analysis; Risk Factors; Sepsis; Smoking; Smoking - adverse effects; Smoking - epidemiology; Statistical analysis; Surgery; Surgical outcomes; Surgical site infections; Variables; Ventilators; Wound dehiscence; Wounds; Elective surgical procedures; Digestive system surgical procedures; Postoperative complications; Smoking
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2021.06.002

Understanding modifiable surgical risk factors is essential for preoperative optimization. We evaluated the association between smoking and complications following major gastrointestinal surgery. Patients who underwent elective colorectal, pancreatic, gastric, or hepatic procedures were identified in the 2017 ACS NSQIP dataset. The primary outcome was 30-day death or serious morbidity (DSM). Secondary outcomes included pulmonary complications, wound complications, and readmission. Multivariable logistic regression was used to evaluate the association between smoking and these outcomes. A total of 46,921 patients were identified, of whom 7,671 (16.3%) were smokers. Smoking was associated with DSM (23.2% vs. 20.4%, OR 1.15 [1.08–1.23]), wound complications (13.0% vs. 10.4%, OR 1.24 [1.14–1.34]), pulmonary complications (4.9% vs 2.9%, OR 1.93 [1.70–2.20]), and unplanned readmission (12.6% vs. 11%, OR 1.14 [95% CI 1.06–1.23]). Smoking is associated with complications following major gastrointestinal surgery. Patients who smoke should be counseled prior to surgery regarding risks. •Smoking is associated with complications after gastrointestinal surgery.•Risk of pulmonary complications is particularly high.•Smoking cessation may be an important part of preoperative optimization.