Smoking and Perioperative Outcomes

被引:249
作者
Turan, Alparslan [1 ]
Mascha, Edward J. [1 ,2 ]
Roberman, Dmitry [1 ]
Turner, Patricia L. [3 ]
You, Jing [1 ,2 ]
Kurz, Andrea [1 ]
Sessler, Daniel I. [1 ]
Saager, Leif [1 ]
机构
[1] Cleveland Clin, Dept Outcomes Res, Cleveland, OH 44195 USA
[2] Cleveland Clin, Dept Quantitat Hlth Sci, Cleveland, OH 44195 USA
[3] Univ Maryland, Sch Med, Dept Surg, Baltimore, MD 21201 USA
关键词
MODELING TOTAL EXPOSURE; CIGARETTE-SMOKING; POSTOPERATIVE COMPLICATIONS; PLASTIC-SURGERY; WOUND-INFECTION; PATIENT SAFETY; RISK; MORTALITY; CESSATION; SMOKERS;
D O I
10.1097/ALN.0b013e318210f560
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Patients are often concerned about the effects of smoking on perioperative risk. However, effective advice may be limited by the paucity of information about smoking and perioperative risk. Thus, our goal was to determine the effect of smoking on 30-day postoperative outcomes in non-cardiac surgical patients. Methods: We evaluated 635,265 patients from the American College of Surgeons National Surgical Quality Improvement Program database; 520,242 patients met our inclusion criteria. Of these patients, 103,795 were current smokers; 82,304 of the current smokers were propensity matched with 82,304 never-smoker controls. Matched current smokers and never-smokers were compared on major and minor composite morbidity outcomes and respective individual outcomes. Results: Current smokers were 1.38 (95% CI, 1.11-1.72) times more likely to die than never smokers. Current smokers also had significantly greater odds of pneumonia (odds ratio [OR], 2.09; 95% CI, 1.80-2.43), unplanned intubation (OR, 1.87; 95% CI, 1.58-2.21), and mechanical ventilation (OR, 1.53; 95% CI, 1.31-1.79). Current smokers were significantly more likely to experience a cardiac arrest (OR, 1.57; 95% CI, 1.10-2.25), myocardial infarction (OR, 1.80; 95% CI, 1.11-2.92), and stroke (OR, 1.73; 95% CI, 1.18-2.53). Current smokers also had significantly higher odds of having superficial (OR, 1.30; 95% CI, 1.20-1.42) and deep (OR, 1.42; 95% CI, 1.21-1.68) incisional infections, sepsis (OR, 1.30; 95% CI, 1.15-1.46), organ space infections (OR, 1.38; 95% CI, 1.20-1.60), and septic shock (OR, 1.55; 95% CI, 1.29-1.87). Conclusion: Our analysis indicates that smoking is associated with a higher likelihood of 30-day mortality and serious postoperative complications. Quantification of increased likelihood of 30-day mortality and a broad range of serious smoking-related complications may enhance the clinician's ability to motivate smoking cessation in surgical patients.
引用
收藏
页码:837 / 846
页数:10
相关论文
共 42 条
[1]  
Adhikari B., 2009, Morbidity and Mortality Weekly Report, V58, P29
[2]   If you continue to smoke, we may have a problem:: Smoking's effects on plastic surgery [J].
Aköz, T ;
Akan, M ;
Yildirim, S .
AESTHETIC PLASTIC SURGERY, 2002, 26 (06) :477-482
[3]   Lack of Correlation between Smoking Status and Early Postoperative Outcome following Valve Surgery [J].
Al-Sarraf, N. ;
Thalib, L. ;
Hughes, A. ;
Tolan, M. ;
Young, V. ;
McGovern, E. .
THORACIC AND CARDIOVASCULAR SURGEON, 2008, 56 (08) :449-455
[4]   Effect of smoking on short-term outcome of patients undergoing coronary artery bypass surgery [J].
Al-Sarraf, Nael ;
Thalib, Lukman ;
Hughes, Anne ;
Tolan, Michael ;
Young, Vincent ;
McGovern, Eillish .
ANNALS OF THORACIC SURGERY, 2008, 86 (02) :517-523
[5]  
[Anonymous], 1988, STAT POWER ANAL BEHA
[6]   Effects of smoking on pulmonary functions and arterial blood gases following coronary artery surgery in Turkish patients [J].
Arabaci, Ü ;
Akdur, H ;
Yigit, Z .
JAPANESE HEART JOURNAL, 2003, 44 (01) :61-72
[7]   Effects of Timing and Extent of Smoking, Type of Cigarettes, and Concomitant Risk Factors on the Association Between Smoking and Subclinical Atherosclerosis [J].
Baldassarre, Damiano ;
Castelnuovo, Samuela ;
Frigerio, Beatrice ;
Amato, Mauro ;
Werba, Jose P. ;
De Jong, Arienne ;
Ravani, Alessio L. ;
Tremoli, Elena ;
Sirtori, Cesare R. .
STROKE, 2009, 40 (06) :1991-1998
[8]   Crucial aspects of smoking in wound heating after breast reduction surgery [J].
Bartsch, Rudolf Heinrich ;
Weiss, Gabriel ;
Kaestenbauer, Thomas ;
Patocka, Kurt ;
Deutinger, Maria ;
Krapohl, Bjorn Dirk ;
Benditte-Klepetko, Heike Christina .
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, 2007, 60 (09) :1045-1049
[9]   Cigarette smoking, plastic surgery, and microsurgery [J].
Chang, LD ;
Buncke, G ;
Slezak, S ;
Buncke, HJ .
JOURNAL OF RECONSTRUCTIVE MICROSURGERY, 1996, 12 (07) :467-474
[10]   Down modulation of IFN-γ signaling in alveolar macrophages isolated from smokers [J].
Dhillon, Navneet K. ;
Murphy, William J. ;
Filla, Michael B. ;
Crespo, Ana J. ;
Latham, Heath A. ;
O'Brien-Ladner, Amy .
TOXICOLOGY AND APPLIED PHARMACOLOGY, 2009, 237 (01) :22-28