Impact of smoking on perioperative outcomes after major surgery

• Published in: The American journal of surgery Vol. 210; no. 2; pp. 221 - 229.e6
• Main Authors: Schmid, Marianne, M.D, Sood, Akshay, M.D, Campbell, Logan, M.D, Kapoor, Victor, M.D, Dalela, Deepansh, M.D, Klett, Dane E., M.D, Chun, Felix K.-H., M.D, Kibel, Adam S., M.D, Sammon, Jesse D., D.O, Menon, Mani, M.D, Fisch, Margit, M.D, Trinh, Quoc-Dien, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2015; Elsevier Limited
• Subjects: Abdomen; Aged; Aneurysms; Body mass index; Bone surgery; Cancer; Cardiovascular; Cardiovascular Surgical Procedures; Codes; Confidence intervals; Coronary vessels; Disease; Female; Heart attacks; Heart surgery; Humans; Hysterectomy; Infections; Male; Medical diagnosis; Medical personnel; Middle Aged; Mortality; Neoplasms - surgery; Oncologic; Orthopedic; Orthopedic Procedures; Perioperative outcomes; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Smoking; Smoking - adverse effects; Surgery; Surgical outcomes; Tobacco; Veins & arteries; Perioperative outcomes; Oncologic; Cardiovascular; Surgery; Orthopedic; Smoking
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2014.12.045

Abstract Background To investigate the impact of smoking on perioperative outcomes in patients undergoing one of the 16 major cardiovascular, orthopedic, or oncologic surgical procedures. Methods We relied on the American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2011). Procedure-specific multivariable logistic regression models assessed the association between smoking status (non, former, or current smokers) and risk of 30-day morbidity and mortality. Results Overall, 141,802 patients were identified. A total of 12.5%, 14.6%, and 14.9% of non, former, and current smokers, respectively, experienced at least one complication ( P < .001). In multivariable models, current smokers had higher odds of overall, pulmonary, wound, and septic/shock complications following most cardiovascular and oncologic surgeries compared with nonsmokers. The odds of experiencing such adverse outcomes were significantly lower in former smokers compared with current smokers, but still higher compared with nonsmokers. Conclusions The effect of smoking on perioperative outcomes is procedure dependent. Current and, even though mitigated, former smoking negatively influence outcomes following cardiovascular or oncologic procedures. Patients undergoing major procedures should be encouraged to discontinue tobacco smoking to achieve optimal procedural outcomes.